When X-rays show multiple well-demarcated periapical radiolucencies, what is the next step?

In situations where X-rays reveal multiple well-demarcated periapical radiolucencies, the most appropriate next step would be performing pulp testing. This approach allows for the assessment of the vitality of the pulp within the affected teeth. By conducting pulp testing, you can determine whether the pulp is alive, necrotic, or in a state of irreversible pulpitis.

Knowing the status of the pulp is crucial because it guides further treatment decisions. If the pulp is necrotic or irreversibly inflamed, this may indicate that root canal therapy is necessary. However, if the pulp is still vital, other less invasive treatments may be warranted.

This assessment is essential before jumping to treatments such as initiating root canal therapy, which may not be appropriate if the pulp is healthy. Likewise, options like incision and drainage or extraction may not be warranted until the vitality of the tooth is understood.