Root-canal Retreatment Assessment Form

Kigo Dental - Self Assessment form for the need for Root Canal Re-treatment.

The following is a self-assessment to help you identify factors that may determine your need for root canal re-treatment. The assessment is meant to be informative but does not substitute for a comprehensive dental evaluation by your dentist or endodontist to determine your actual needs and condition.

Root canal retreatment

Be sure to answer all the questions honestly to obtain an accurate score. Hereafter "you" can be related to you, your child, or any person in need of taking this test.

1. Are you experiencing pain or sensitivity when chewing or biting on root canal-treated teeth?
Yes No

2. Are you experiencing any redness, swelling or tenderness in the root canal-treated teeth or gums around the root canal-treated teeth?
Yes No

3. Have you noticed any discolouration or darkening of the root canal-treated teeth or gums around the root canal-treated teeth?
Yes No

4. Have you noticed any chipping or cracking of the root canal-treated teeth? Are you having any issues with food getting stuck around the root canal-treated teeth?
Yes No

5. Are you experiencing any lingering pain or sensitivity to hot or cold temperatures in the root canal-treated teeth or gums around the root canal-treated teeth?
Yes No

6. Have you had any recent trauma or injury to the root canal-treated teeth?
Yes No

7. Have you noticed drainage or discharge from the root canal-treated teeth or surrounding gum tissue? Have you noticed any bad taste or odour from root canal treated teeth?
Yes No

8. Do you have any medical conditions that may affect your dental health, such as diabetes, heart disease, or immune system disorders?

Yes, but it is well-controlled Yes, and it is not well-controlled No

9. Have you had any recent surgeries or treatments that may affect your dental health, such as radiation therapy or chemotherapy?
Yes No

10. Are you willing and able to commit to the multiple appointments required for root canal retreatment, including initial consultation, x-rays, and follow-up visits?
Yes No

11. Are you willing and able to follow post-treatment instructions for the retreatment, including taking any prescribed medications, avoiding certain foods or activities, and attending follow-up appointments as needed?
Yes No

12. Have you experienced difficulty flossing or cleaning around the area where the crown or bridge is located?
Yes No

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Note: Please note that this self-assessment form does not intend to provide a definitive diagnosis if you need root canal re-treatment or other health conditions; it is developed to give you approximate knowledge about the need for root canal re-treatment so that you can get appropriate consultation. Consulting with a qualified healthcare professional is mandatory to get a definitive diagnosis.

Root-canal Retreatment Assessment Form

Kigo Dental - Self Assessment form for the need for Root Canal Re-treatment.

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