Based on the symptoms described, RCT cannot be advised solely on the basis of this X-ray. Pain with cold and on chewing can occur with a deep carious lesion, but the key factor is whether the cold pain lingers after the stimulus is removed. If the pain is brief and stops quickly, the pulp may still be capable of healing and a filling/pulp-preserving treatment may be possible. However, if the cold pain lingers significantly, occurs spontaneously, or the tooth is markedly tender to biting/percussion, RCT may be necessary. The X-ray also appears to show a problematic lower wisdom tooth in close proximity to the second molar, which should be clinically evaluated.
Next Steps
Get a clinical examination, cold pulp test, percussion/bite test and a good-quality IOPA. Then the dentist can decide whether a filling/pulp therapy or RCT is appropriate. The wisdom tooth also appears to be impacted and should be evaluated.
Health Tips
If you want to avoid RCT, don’t delay treatment. A filling can last several years when properly done, while a properly treated and restored RCT tooth can also last 10+ years, often longer.