Nice clear radiographs — thanks. I’ll give a focused clinical/radiographic read, a 0–14 day action plan you can use now, likely definitive options, what will get worse if ignored, and short practical comments for the patient and clinician.

Radiographic diagnosis (concise)

• The images show a deep carious lesion extending into the pulpal chamber of a posterior tooth (likely a mandibular molar from the root morphology).

• The caries appears to have progressed rapidly from enamel/dentin into the pulp; there is loss of coronal tooth structure and a widened pulp chamber outline consistent with pulpitis / pulpal involvement.

• I do not see a large, well-defined periapical radiolucency in these images (no obvious chronic apical abscess), but early periapical changes can be subtle — pulp necrosis may already be present or developing.

• Radiographic impression: Deep caries with probable irreversible pulpitis or early pulpal necrosis → endodontic treatment likely indicated. If the tooth is non-restorable clinically, extraction is the alternative.

Clinical tests to perform now (if you’re the treating dentist)

1. Vitality testing: cold test + EPT (compare adjacent teeth).

2. Percussion and palpation.

3. Periodontal probing to rule out vertical/root fracture or perio involvement.

4. Bite test to detect cracked-tooth pain.

5. Periapical radiograph(s) at different angulations; cone-beam (CBCT) only if planning complex retreatment or assessing root morphology.

6. Document symptoms: spontaneous pain, nocturnal pain, swelling, fistula, systemic signs.

Urgency & when to treat

• If patient has swelling, fever, cellulitis or difficulty opening/ swallowing → emergency same-day care.

• Otherwise: urgent — schedule endodontic evaluation/therapy within 3–7 days. Delaying longer (weeks–months) increases risk of abscess, spread, and possible tooth loss.

0–14 day practical care plan (what to do now)

Day 0–2 (triage):

• Control pain: prescribe/advise appropriate analgesics (NSAID ± paracetamol per local dosing).

• If there are systemic infection signs or rapidly spreading infection, start antibiotics (amoxicillin ± metronidazole) per guidelines — remember antibiotics do not treat pulpitis, only adjunct to spreading infection control.

• If patient unable to attend immediate RCT and is symptomatic, consider emergency pulpotomy (if tooth is restorable and child/ adult cooperation allows) or placement of temporary medicated dressing to reduce symptoms.

Day 3–14 (definitive scheduling):

• Plan/perform root canal treatment (RCT) if tooth is restorable and patient accepts endo. RCT can be done in single or multiple visits depending on infection, anatomy, and clinician preference.

• If coronal structure is insufficient for restoration, consider extraction and discuss space/successor tooth considerations (if applicable).

• Following RCT: restore with a definitive coronal restoration; for posterior teeth consider a full coverage restoration (onlay/crown) to prevent fracture and re-infection.

Expected short-term results (14 days):

• Pain and acute symptoms should markedly improve within 24–72 hours after appropriate endodontic therapy or emergency pulpal procedures.

• Radiographic periapical healing requires months; absence of acute symptoms ≠ complete resolution of periapical radiolucency.

Definitive treatment options (short)

• Pulpotomy/pulp therapy (only if reversible/partial pulpal involvement and indicated) — rare for adult permanent molars.

• Conventional RCT → obturation → permanent coronal restoration (composite/onlay/crown).

• Extraction when tooth is unrestorable or patient preference/financial constraints; discuss replacement options (implant, bridge, space maintainer if juvenile).

• If complex anatomy or persistent symptoms → refer to endodontist (microscope/CBCT).

What will scale up if untreated

• Progression to pulpal necrosis → acute apical abscess, sinus tract, cellulitis, possible systemic spread.

• Increased treatment complexity and cost (from simple filling → RCT → possible extraction + prosthetic replacement).

• Risk of tooth fracture when coronal tooth structure is weak.

• Adjacent tooth/periodontium involvement or chronic infection impacting overall health.

Communication points to give the patient

• “Delaying a small filling can allow bacteria to reach the nerve — that’s why what was a small appointment now needs RCT or extraction.”

• RCT aims to remove infection and save the tooth; success rate is high but long-term success needs a good coronal seal/crown.

• If pain/swelling develops — come back immediately.

Suggested workflow for clinician (concise)

1. Triage (phone/symptom check) → urgent appointment as needed.

2. Full clinical exam + pulp tests + periapicals (or CBCT if indicated).

3. If symptomatic reversible pulpitis: restore promptly. If irreversible pulpitis/necrosis: plan RCT or extraction.

4. Provide analgesia/antibiotics only when indicated.

5. Definitive restoration after endo within 1–4 weeks to prevent reinfection.

Short timelines summary

• Emergency control (pain/infection): immediate (day 0–2).

• Endodontic therapy scheduling: within 3–7 days ideally.

• Symptom relief: often within 24–72 hours after RCT or proper pulpal procedure.

• Radiographic periapical healing: 3–12 months depending on lesion size.

Local referral (your link)

For clinicians/patients in Cebu: use your clinic directory — https://cebudentalimplants.com/map-dental-clinic