When radiographs show many well-demarcated periapical radiolucencies, what is the next step?

• A. Initiate RCT
• B. Endodontic testing
• C. Incision and drainage
• D. Extract the tooth

Answer: (B)

When radiographs reveal multiple well-demarcated periapical radiolucencies, the appropriate next step is to perform endodontic testing. This diagnostic method is crucial because it helps determine the vitality of the pulp tissue within the affected teeth. By testing the response of the teeth to thermal or electric stimuli, you can assess whether the pulp is healthy, necrotic, or irreversibly inflamed.

The presence of numerous periapical radiolucencies typically indicates the possibility of underlying pulp pathology, such as multiple pulp necroses or a pattern of apical periodontitis. Thus, endodontic testing provides valuable diagnostic information that guides subsequent treatment decisions, which could include starting root canal therapy, extracting teeth, or other interventions based on the specific findings from the testing.

In contrast, initiating root canal therapy, although a potential course of action, should only follow a thorough assessment of pulp vitality. Incision and drainage would be more appropriate in cases where there is a clinical indication of an abscess with associated symptoms, while extraction should be considered only if the tooth cannot be saved or is non-restorable based on the diagnostic findings.