Risk management in root canal treatment

Recognise your technical limits when performing root canal treatment and be prepared to refer patients if necessary.

The British Endodontic Society states that if carried out to a good standard, the success rate of root canal procedures is up to 90%, but the DDU receives a significant number of endodontic claims and complaints each year.

In the ten-year period up to 2020, there were 1,164 claims involving root canal treatment, as a primary element of the claim and root canal treatment featured in 1,715 files notified in this period by DDU members. A great many of these claims relate to avoidable adverse incidents such as inhaled or ingested endodontic instruments, or hypochlorite extrusion injuries.

As root canal treatment demands a higher level of technical skill than many other dental restorations, there are several risk factors to consider.

  • Dentists should know their limitations and be prepared to refer patients to a specialist, if this is in the patient's best interests.
  • It's important to warn patients about possible complications (such as damage to an existing crown, risk of post-treatment flare-ups, or risk of failure and subsequent tooth loss) so they can give valid consent and have realistic expectations.

DDU advice

  • Carry out a thorough pre-treatment assessment including relevant history and radiographs. Be aware of risk factors such as the type of tooth, its accessibility and the morphology of the canal and root.
  • Don't feel pressurised to undertake a procedure simply because the patient requests it, if referral is in their best interests.
  • When referring to an endodontist, make sure you've provided all relevant information, including histories and radiographs.
  • Warn patients about material risks that they are likely to regard as significant. The question of whether the information given to a patient is adequate is judged from the perspective of a reasonable person in the patient's position.
  • Use language the patient can understand, and avoid jargon.
  • Keep a clear record of the treatment provided and warnings given.
  • Keep up to date with current techniques and follow relevant protocols and guidance, such as on the use of rubber dam and sodium hypochlorite.
  • Take post-treatment radiographs, provide suitable aftercare advice and monitor the patient after treatment. Be ready to review your treatment plan if the patient's condition doesn't improve as expected or they experience ongoing infections or pain.
  • If something does go wrong during treatment, apologise to the patient and explain what you are going to do next, such as referring them to hospital.

This page was correct at publication on 02/06/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.