What should be done in the case of a patient with a large amalgam restoration sensitive to cold?

When a patient has a large amalgam restoration that is sensitive to cold, the most appropriate action is to replace the restoration. This sensitivity can indicate several potential issues related to the restoration itself, such as microleakage, chipping, or even the presence of a crack in the tooth. Replacing the restoration allows the dentist to properly assess the underlying tooth structure while removing any defective materials that may be contributing to the sensitivity.

In doing so, the dentist can also ensure that the new restoration fits correctly and re-establishes a proper seal, potentially alleviating the discomfort the patient is experiencing.

In contrast, extracting the tooth would be an extreme measure unless there is significant evidence of non-restorability or advanced disease, and performing a root canal treatment may not address the problem if the issue lies with the restoration rather than the pulp of the tooth. Monitoring without intervention may lead to further complications or prolonged discomfort, making it a less favorable option. Therefore, replacing the restoration is the most effective approach to resolving sensitivity issues while providing optimal care for the patient.