A young dentist asked me: “How do you tell the patient that an endodontic file is separated inside the root canal?”
This is one of the difficult moments for any dentist who perform root canal treatment may run into.
Before answering the question, there are 2 concepts we need to first understand.
- Expectation vs Excuse (patient’s perception about the incident)
- Prevention is better than cure
Expectation - Tell the patient about the possible undesirable outcome BEFORE the incident happens
Excuse - Tell the patient about the undesirable outcome AFTER the incident happened
If you have forgotten to tell your patient about the possible undesirable outcome before you begin treatment, you have just put yourself into a very sticky situation. And the chances are.... you are going to have certain extent of impact to your reputation, finances, self-confidence and emotion health.
Therefore, for all root canal treatments, it is MANDATORY to have a written consent that clearly explained all the possible undesirable outcomes and the patient must be fully understood and signed.
“Risks of separation of instrument” must be one of the items in the consent form.
If you don’t have time to go through the consent and get the patient to understand and sign, DO NOT BEGIN root canal treatment... just perform a pulpotomy & place a medicated dressing. ONLY begin root canal treatment upon obtaining consent.
Why does an endodontic file separates?
- Cold work on files (hand file) - bending and flexing repeatedly
- Instrument fatigue (rotary file)
- No proper glide path
- Extreme curvature of the root canal
Prevention is ALWAYS better than cure.
Other than obtaining consent for the endodontic treatment, the best habit is always to use NEW endodontic files for your patients - K files, rotary files and etc...
Yes, there will definitely be an extra cost on the instruments. You have to decide if you are going to incorporate the cost into the treatment fee or charge it to your patient separately.
For my practice, I charge an endodontic instrument fee to my patients.
Now go back to the question: How to tell the patient about separation of instrument?
1. Stop the procedure and take an X-ray
2. Place a dressing on the tooth
3. Inform the patient that a portion of the instrument was separated and left inside the canal - “I am sorry to inform you that a portion of the endodontic instrument was separated inside the root canal”
4. Discuss options
- Bypass the separated instrument
- Attempt to remove the separated instrument
Either options with take up extra time and visits
5. Discuss who is going to carry out the procedure
- You
- Referred to Endodontist
6. Discussion on extra treatment fee and treatment time