Stay safe with root treatment

Paul Lambden explains why maintaining clear, evidence-based communication is so important in endodontics, including root canal treatment.

Plaintiff law firms are filing increasing numbers of claims against dentists related to root canal treatments. For attorneys, spotting a problem can be easy because the information they need to succeed on a claim will be visible by examining the patient, looking at the x-rays, or reading the notes.

Dentists often do the right things and provide care to the best of their ability, but fall prey to plaintiffs’ attorneys for not taking the proper steps to not only explain, but document the facts and all the risks at every stage.

Effective protocols for root treatment

Most claims could be avoided by ensuring compliance with some simple steps:

1. Make sure an up-to-date preoperative radiograph is available
2. Inform the patient about the condition of the tooth. Explain that:
   • The tooth is in very poor condition and if root canal therapy fails, extraction is the only alternative. Radical treatment is a last resort option
   • Tell them that root canal treatments can be difficult and may fail because the tooth is cracked or too decayed. The roots may be very curved, the canals very thin or hardened. An instrument may break in the channel. Hypochlorite can rarely leak. Make it clear that root canal treatment does not guarantee retention of the tooth. Document these warnings
3. Always use a rubber barrier. It is now considered negligent by many not to do so
4. If the patient chooses not to have treatment because the tooth is not painful, make sure it is understood that the root of the tooth is infected, that at some point it will swell, the infection may spread and the patient may become unwell. Document these warnings
5. Remember GDC Standard 7.2.2: “Only provide treatment and care if you are satisfied that you have had the necessary training and are competent to do so. If you are unsure of the treatment, you should refer the patient to a suitably trained colleague.’
6. Make sure you have a post-op radiograph that clearly shows the root apices.

Final warnings

It is important to warn the patient that root-treated teeth are fragile and may subsequently need to be crowned.

Finally, emphasize that root canal treatments can fail even when done well.

To be safe, make sure all hazards as above are documented.

If you choose to proceed with radical treatment but find it too difficult, stop. Notify the patient, explain the options and make the necessary arrangements. Do not raise the patient’s expectations too high: many root canal treatments ultimately fail.

With good, comprehensive records, documentation of risks, proper consent and clear explanations, the dentist is less vulnerable and can avoid the agony of a claim and such huge payouts can be avoided.