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When there is a tooth pain, it means that the infection has reached the pulp of the tooth. The pulp of the tooth is the innermost part of the tooth where the blood vessels and the nerves are present. In the crown portion of the tooth, it is called pulp chamber, and in the root portion, it is called as a root canal.Once the infection has reached the pulp, it will involve both the pulp chamber as well as the root canal, and it spreads to the tissues below the tooth. The treatment is, to remove the infected tissues and clean the root canal and pulp chamber. This is known as a root canal treatment. I have seen your x-ray (attachment removed to protect patient identity). From this x-ray, the right side first molar appears to be the tooth of concern and needs a root canal procedure. The radiograph (x-ray) is additional to a clinical examination. Radiograph alone is not conclusive for a diagnosis. Changes in angulation of x-ray machine or position of the patient can cause overlapping of images of adjacent structures, giving a false diagnosis.