One patient in the dental care can hardly be expected to have knowledge and understanding of all the factors that can and should be taken into consideration before a clinical decision about endodontic surgery. The patient has the right to know what the treatment entails, how risky and painful it is and what impact it is likely to bring with them to undergo treatment and to refrain from it. This implies a corresponding requirement for dental staff to ensure that this information is provided and that it is done in a way that the patient can actually understand. In practice, of course, there is a limit to how detailed the information can and should be. As long as the choice of methods, equipment and materials to carry out an endodontic surgery is considered as the standard, there is no reason to go into small details. If the patient asks many questions about the equipment and methods, this can be an expression of concern or, at worst, distrust rather than a genuine desire for more detailed information. As important as providing answers to all the questions then it is to try to establish or re-establish trust. The patient should be able to rely on dentist’s knowledge based on science and proven experience and that they follow both the technological and scientific developments in the field. They should also be confident that the dentist has the best for the patient as their primary goal.

For completeness of the information something must be said about the risks associated with the suggested treatment and about refraining from treatment. In this particular case, this is complicated significantly due to the fact that evidence is lacking about how the untreated apical periodontitis affects individuals both locally and systemically.

There are two basic aspects of risk: some kind of negative consequence and the probability that it will occur. The negative consequence or injury may be more or less severe. The most serious negative consequences in health care, including dentistry, are life-threatening. Such consequences are also highly unusual in dental practice including surgical procedures.

It is clearly important to inform the patient in the case of relatively high probability of severe consequences (if any treatments at all should be carried out), while it seems unimportant to communicate very unlikely minor damages. In many other cases, it is difficult to know how to do. If there had been only advantages to inform there would have been no reason to hesitate. What complicates the matter is that information in itself can cause injury. First, risk information may cause anxiety, and it can make patients refrain from treatments because of unrest despite that the risks otherwise would be reasonable to accept. This is why there may be reason to wonder, for example, whether to communicate a very small likelihood of great harm. Primarily because it is a concern from dentist’s point of view to promote patient’s oral health, but also from the autonomy perspective, it is sometimes questionable whether such information should be given. The fear of an unlikely but serious injury may counteract the ability of the patient to rationally reflect on the options and come to an autonomous decision. Exactly what considerations that should be made are debatable. How much and what to inform varies with the situation and who is the patient. Some patients prefer not to know the risks unless it is clearly relevant. The dentist needs to know in advance both those who are keen to get information and those who would prefer to avoid. If the patient visited the practice on a regular basis for several years and is well known, it may be possible for the dentist to give properly balanced information. But as in the case of endodontic surgery, where many patients have been referred to an endodontist or oral surgeon specifically for this treatment, the dentist is lacking this knowledge of the patient. Being in this situation, to ask the patient if he or she wants risk-related information does not work well because the patient will then easily conclude that the caregiver has important risk information because otherwise he or she would not have asked.

When deciding about a tooth in need of endodontic surgery the economic aspect of the treatment is often one, if not decisive, then at least very important factor. Since surgical endodontics does not require the dismantling of functional prosthodontics constructions, it is often a less expensive alternative for the patient. But the costs of both surgical and nonsurgical treatment of course vary both in different countries between operators and between countries with different systems of reimbursement by insurance. It is important that information about the costs and possible reimbursement by insurance are correct and that it does not change.

When the patient is informed about the facts regarding diagnoses, treatment options, risks and costs, he or she must be allowed to choose what she or he wants to do in the given situation. The individual has a right not to be forced or manipulated to undergo medical or dental treatments. However, it is difficult to imagine that the dentist can completely avoid the influence. The positive approach to good oral and dental health and, in this particular case, the importance of restoring periapical health are likely to affect the patient to some degree. One might think that it is also reasonable, since good periapical health is in the interests of the patient. Here, there is an important balancing act so that patient autonomy is not compromised. The endodontist or oral surgeon must develop sensitivity to patients’ varying values and preferences. Particularly important is the responsiveness if the patient’s ability to exercise their autonomy is compromised.

Many patients lack all or part of the capacity for autonomous decision-making. It may involve children, mentally ill, mentally retarded or demented individuals. It is important to remember that these patients have the right to be treated with care and respect. A fruitful way to address the challenge of information and consent for these patients is to allow them to exercise their autonomy as best they can, and otherwise let them express their willingness or unwillingness to cooperate.

In the absence of the ability to understand, to take a stand and to make decisions, the informed consent can be authorized to a close relative or another person close to the patient.

Social development has led to the conclusion that we are currently seeing the patient’s right to autonomous decision-making as an integral part of both dental care and other health services. Procedures for obtaining informed consent play a key role in safeguarding this right. In the context of endodontic surgery, informed consent means that the patient after having been informed of and understand the relevant aspects of the offered surgical procedure may determine whether to say yes or no to the dentists’ suggestion of treatment. The information shall include a description of the course of treatment, the pros and cons of the surgery, and what it costs. Whether to perform a retreatment or not is a complex decision-making situation. Many factors have to be considered. For the dentist who made the diagnosis and who is about to suggest a treatment, both biological considerations and the potential and limitations of different options have to be deliberated. Equally important are the preferences of each individual patient. The subjective meaning of the situation will vary among patients. Only the patient is the expert on how he or she feels about keeping a tooth with or without retreatment or perhaps extracting it, which symptoms are tolerable, which risks are worth taking and what costs are acceptable.