A detailed clinical examination should be repeated, including cusp-by-cusp bite testing, periodontal probing, percussion, palpation, occlusal assessment and transillumination for cracks. The adjacent teeth should also be tested for comparison. If dental findings remain normal, consider further evaluation for non-dental causes of the headache/facial pain rather than starting RCT or extraction without a confirmed diagnosis.

Do not proceed with root canal treatment or extraction solely on the basis of pain when objective dental findings are absent. Seek urgent dental/medical assessment if swelling, fever, difficulty opening the mouth, swallowing or breathing develops.