Consents | Policies | Instructions

CONSENT TO ENDODONTIC CONSULTATION & TREATMENT

This section outlines your endodontic consultation and treatment. Please read carefully and ask any questions. Your comfort and understanding are our priorities.

Purpose of Endodontic Treatment and Prognosis

Root canal therapy addresses infections within the tooth, aiming to preserve the natural tooth either permanently or as a preliminary step before further restoration. While endodontic treatment generally yields successful outcomes, results can vary. If unsuccessful, additional procedures or extraction may be required. Treatment outcomes cannot be guaranteed.

Endodontic Consultation

During an endodontic consultation, your healthcare provider will thoroughly review your medical and dental history to identify factors influencing the safety and success of the treatment. They will discuss potential risks and benefits and may perform clinical tests, take X-rays, and conduct diagnostic interviews. Although diagnoses are typically accurate, they are not infallible; sometimes symptoms must worsen before treatment can commence, leading to delays. You may be referred to other healthcare professionals for further evaluation, and occasionally a tooth not causing symptoms may be treated.

Radiographs (“X-rays”), including 2D and 3D (“CB-CT”) imaging, are essential for precise diagnosis and treatment planning, exposing you to low levels of radiation comparable to natural background levels. You have the right to refuse radiographs; however, this could compromise the accuracy of the diagnosis and quality of the treatment, and your provider may decide not to proceed without them. It is crucial to inform your provider about all medical conditions, including pregnancy, to ensure the safety and effectiveness of your treatment plan.

Alternative Choices to Endodontic Treatment

Endodontic treatment is one option among others. You could opt for extraction, although replacing the tooth may not always be feasible. You can seek a second opinion on your diagnosis and treatment options or choose to forgo treatment entirely.

Consequences of No Treatment

Choosing not to treat a dental issue may lead to pain, swelling, infection, urgent medical needs, and tooth loss. Your provider might prescribe antibiotics for temporary relief, but proper treatment is needed to address the root cause. Delaying endodontic treatment can complicate the procedure and impact the results.

Endodontic Treatment Risks and Considerations

Endodontic treatments carry risks ranging from minor temporary issues to serious lasting outcomes. Evaluate these risks against the benefits and discuss concerns with your provider to make an informed decision.

Exacerbation of Existing Medical Conditions

Inform your provider of all medical conditions and medications, as they may affect your treatment plan or render endodontic treatment unsuitable. Treatment stress or medications could impact existing conditions and necessitate urgent medical attention. Consult your doctor to ensure you are fit for treatment.

Reaction to Materials and Medications

Materials or medications used during treatment may cause allergies, side effects, or interact with other medications. Share a complete list of all medications you take (prescribed or over the counter) with your provider. Consult your doctor or pharmacist if you have questions about new medications.

Jaw Joint Pain (TMD)/Headaches

Treatment sessions, which last between 1 to 1.5 hours, can cause soreness in the jaw joint and muscles. In rare instances, this may lead to or exacerbate temporomandibular joint dysfunction (TMD), resulting in limited jaw movement, joint pain, clicking noises, headaches, or earaches. These conditions are typically temporary but may require assessment and intervention by other healthcare providers.

Local Anesthesia

Local anesthetics provide pain-free treatment, but they may interact with other medications or impact medical conditions. It is important to disclose all medical conditions and medications to your provider. Risks of local anesthesia include pain at the injection site, muscle spasms, tissue damage, swelling, bruising, limited jaw opening, extended numbness, and potentially reversible or rarely irreversible nerve damage. Nerve damage can result in sensory changes, loss of sensation, or neuropathic pain. Though generally temporary, nerve damage can occasionally be permanent. Other risks include separation of the anesthetic needle in tissues and accidental injection near or into blood vessels, which may cause increased heart rate, anxiety, fainting, or conditions requiring urgent medical attention.

Damage to Adjacent Structures

Despite best efforts, unintended damage to surrounding tissues or restorations may occur during treatment, affecting bone, teeth, gums, or existing restorations. This may necessitate new restorations at the patient's expense. Other risks include bone infection, necrosis, nerve damage (leading to loss of sensation or function), and damage to blood supply, sinus cavity, existing implants, and adjacent tooth roots. While most injuries heal over time, some may have lasting effects or require further treatment.

Other Risks Associated with Endodontic Treatment

Complications can arise during endodontic treatment despite the provider's best efforts. Instruments used to clean the root canal may separate inside the canal, occasionally necessitating additional procedures. Accidental perforations of the tooth or root are possible, potentially resulting in pain or infection. Some areas of the canal may be inaccessible, hindering complete cleaning or filling and leading to recurrent symptoms. Nearby tissues, nerves, or blood vessels may be affected, causing pain or numbness. For upper teeth, there is a small risk of sinus perforation. In very rare instances, small instruments or materials may be accidentally swallowed or inhaled. Irrigating solutions can cause tissue irritation, and rare allergic reactions to anesthetics or materials may occur. Some patients may experience discomfort during the procedure despite local anesthesia. These complications can impact the prognosis and may require further treatment, including extraction, referral to specialists, or urgent medical care. Discuss any concerns with your provider, who will take every precaution to minimize these risks and ensure the best possible outcome.

After Treatment Conditions and Complications

Following endodontic treatment, common post-operative effects may include pain, discomfort, mild swelling, and sensitivity to pressure, temperature, or touch. Treated teeth can become brittle and darken, and in some cases, infections may require further treatment. Other possible effects are temporary numbness, gum inflammation, and tenderness when chewing. Rarely, patients could experience sinus complications, jaw pain, abscess formation, or cyst development. Nearby teeth might be affected, causing discomfort or damage. Following post-operative care instructions and attending follow-up visits will help ensure proper healing and address any complications promptly.

Cracked/Fractured Teeth

In some cases, a tooth may have a visible crack. In others, a crack may not be noticeable at all until symptoms develop or treatment begins. Even with today’s best technology, some cracks are hidden or extend deeper than we can detect. While root canal treatment can help resolve infection or inflammation inside the tooth, it cannot remove or repair the crack itself. Cracks can make outcomes less predictable. Symptoms may persist, worsen, or return. In some cases, a crack can lead to a vertical root fracture or make the tooth non-restorable, meaning it may need to be extracted, either now or in the future. A crown is typically recommended after treatment to help protect the tooth, but even with a crown, a cracked tooth has a more guarded long-term prognosis.

CONSENT TO USE OF SEDATION

We offer conscious sedation to help patients relax during dental treatment. Conscious sedation is safe but not everyone qualifies; some may need a referral for deeper sedation. Sedation is optional, not required for endodontic treatment.

Nitrous Oxide

Used to relax patients, nitrous oxide does not replace local anesthetics. Reactions vary and some medical conditions may prevent its use. Provide your complete medical history including pregnancy, CHF, COPD, asthma, hepatitis, immune or respiratory diseases, psychiatric issues, substance use, or claustrophobia. You must breathe through your nose. Possible side effects include tingling, heaviness, warmth, laughter, dizziness, detachment, and nausea, which usually disappear within 10 minutes of oxygen administration. Don't drive until all effects are resolved; having someone drive you is recommended.

Oral Sedation

Taken as pills or capsules, oral sedation manages anxiety and discomfort and may be combined with Nitrous Oxide. Inform your provider about recreational drug use, alcohol, certain medications, and pregnancy. Avoid alcohol and CNS depressants. Potential complications include pain, nausea, vomiting, lightheadedness, headache, amnesia, allergic reactions, visual disturbances, and respiratory depression. During the procedure, unexpected situations may require immediate decisions by your provider unless otherwise designated. Due to lasting effects, have someone drive you to and from the appointment.

CONSENT TO FINANCIAL POLICIES

At Integrated Endodontic Solutions, we aim to deliver high-quality specialized care. Our financial policies are designed to help you understand and manage your financial responsibilities. We offer various payment options, and our administrative experts are available to assist you. Our fees reflect the value of our professional services, based on national, state, and local standards for specialized care.

Payments

All payments are due at the time of service. Adult patients (18+ years) are responsible for payment; for minors, parents or legal guardians to assume responsibility.

Dental Benefits | Dental Insurance

Your dental benefits are part of your employment package and are negotiated between your employer and a third-party payor. We do not control the terms of your plan. Dental benefits typically cover preventive services and may assist with portions of other dental costs, subject to specific rules and limitations. We provide estimates based on available information, but actual costs may vary due to insurance limitations or unforeseen conditions. You are responsible for any fees not covered by your insurance. If you have dual coverage, we will help minimize out-of-pocket costs, but ultimate responsibility for any unpaid fees remains with you.

Double Coverage | Coordination of Benefits (COB)

If you have two dental insurance plans—like one from your job and one from your spouse—that’s called dual dental coverage. It doesn’t mean you get double the benefits, but it might help you pay less out-of-pocket. One plan will be your main (primary) and the other will be secondary, and they work together to cover costs, but never more than the total bill. The rules for how they share costs—called coordination of benefits (COB)—depend on your insurance contracts and state laws. Sometimes the second plan pays the leftover amount, sometimes just part of it, and sometimes nothing at all. To know what your plans will cover, it’s best to check directly with your insurance companies before getting treatment.

Insurance Information

We assist with the submission of necessary paperwork to your insurance company, but you are ultimately responsible for any unpaid portions. We coordinate with most insurance companies to reduce out-of-pocket costs, whether in-network or out-of-network. However, reimbursement amounts may vary based on your insurance plan’s policies. Our estimates are as accurate as possible but are not guaranteed quotes. Changes in treatment needs or insurance policies may require adjustments to your estimated patient portion.

Payment Methods

For your convenience, we accept cash/check, credit cards, and CareCredit. Cash or check payments made in full at the time of service receive a 5% discount, and credit card payments made in full receive a 3% discount. CareCredit offers convenient monthly payments with no interest if paid within the promotional period (3 to 12 months, based on credit qualification).

General Payment Policies

General payment policies include the requirement that payment for deductibles and estimated patient portions is due at the time of service. Final costs may vary due to unforeseen conditions or insurance limitations. Patients 65 years and older receive a 5% discount, combinable with other promotions. A 3% finance charge applies to balances over 30 days, and accounts in collection incur additional fees and may result in refusal of future services. Returned checks incur a $40 fee.

Commitment to Quality Care

We uphold the highest standards of treatment and service regardless of your payment method. Our goal is to ensure that financial considerations do not compromise the quality of care you receive.

CONSENT TO APPOINTMENT POLICIES

The "Consent to Appointment Policies" section explains our guidelines for scheduling, rescheduling, and canceling appointments. It's here to ensure that you are fully informed and comfortable with our practices, helping us respect your time and providing you with the best possible care. We value your cooperation in creating a smooth, pleasant, and considerate experience for everyone involved.

Missed or Broken Appointment | No-Show

We handle emergency situations individually, understanding that unexpected events can happen. However, missed appointments can delay your treatment, prevent others from receiving timely care, and increase our costs. To ensure fairness and efficiency, each patient is allowed to miss or cancel up to two appointments without a 48-hour notice within a 12-month period. A third missed appointment within the same period will result in dismissal from our practice or no further scheduling of appointments.

Late to Appointment

We understand that delays can happen and appreciate your understanding and cooperation. If you arrive more than 15 minutes late, we may need to reschedule your appointment to ensure we provide the highest quality of care for you and all our patients. In urgent cases, we might offer care during the shorter time available and complete the treatment over multiple visits. Extending your appointment to accommodate lateness is unfair to other patients who arrive on time. Therefore, please check your schedule to ensure timely arrival, or call us if you are less than 15 minutes late. If lateness significantly shortens your appointment, our "broken appointment" policies may apply. We value your time and strive to provide the best possible care, so your cooperation in helping us maintain our schedule is greatly appreciated. Thank you for your consideration and understanding.

Emergency | Walk-in Appointments

We strive to accommodate urgent care needs within the same day (24-hour cycle) or the next day whenever possible. Regular fees apply during practice hours, with additional fees for after-hours services. Unfortunately, we may be unable to treat patients with unpaid balances over 60 days or those in collections. Additionally, we cannot call in medications for patients not on record or who haven't been recently seen for a procedure or have an upcoming procedure. We may also be unable to treat patients requiring pre-medication. You have the option to visit local urgent care centers, emergency rooms, or other providers if necessary. Our policies ensure your safety and the highest quality of care. Please contact us with any questions about our emergency or walk-in appointment policy. Thank you for your understanding.

CONSENT TO HIPAA POLICIES

This section explains our commitment to protecting your privacy and personal health information (PHI). We need your consent to ensure you understand and agree to our practices for handling your data in compliance with HIPAA regulations. This consent is vital for maintaining trust and transparency in how we safeguard your confidential information, ensuring you feel secure and informed about your privacy rights.

Use and Disclosure of Your Information

We use your PHI to provide and coordinate your care, including sharing necessary information with other healthcare providers involved in your treatment. This ensures you receive comprehensive care. Your PHI is also used to obtain payment for our services and for healthcare operations such as quality assessments and staff training. Additionally, we may use your information to remind you of upcoming appointments. In some cases, we are required by law to disclose your PHI, such as for public health reporting.

Your Rights Regarding Your Information

You have several rights concerning your PHI. You can access and obtain a copy of your health records at any time. If you believe there is an error in your records, you have the right to request corrections. You can request an accounting of disclosures, which is a list of when and why your PHI has been shared, excluding disclosures for treatment, payment, or healthcare operations. You may request that we communicate with you through alternative means or at different locations for added privacy. Additionally, you can ask us to restrict certain uses and disclosures of your PHI. While we will consider all requests, we may not be able to agree to all restrictions. If you feel your privacy rights have been violated, you can file a complaint with our office or the U.S. Department of Health and Human Services.

Protecting Your Information

At Integrated Endodontic Solutions, safeguarding your PHI is a top priority. We employ a variety of measures to ensure its security and confidentiality. We use advanced technical safeguards such as encryption and secure passwords to protect all electronic PHI. Additionally, we have established comprehensive administrative policies and procedures to manage the proper handling and protection of your PHI. These combined efforts reflect our dedication to maintaining the highest standards of privacy and security for your health information.

Response to Breaches

We take any breach of your protected health information (PHI) very seriously. If a breach is suspected or occurs, it must be reported immediately to our Office Manager. We will promptly investigate and take appropriate actions to mitigate any harm and prevent future incidents. If your unsecured PHI has been compromised, we will notify you and, as required, inform the relevant authorities. Our goal is to handle any breaches swiftly and effectively to protect your information and maintain your trust.

Oversight & Compliance

Our Office Manager ensures our practice adheres to HIPAA regulations by overseeing our compliance program and managing all related inquiries and incidents. They conduct training sessions for staff and stay informed about updates to regulations. We take privacy and security seriously, performing annual reviews and updates to our policies to maintain the highest standards. For any questions or concerns about our HIPAA practices, please contact our Office Manager.