The maxillary first molars are the largest teeth in the upper jaw (Universal 3 on the right and 14 on the left, FDI 16 and 26). Each has four main cusps, often with a small extra cusp (the cusp of Carabelli) on the palatal side, and three roots: two buccal and a long palatal root. They erupt at about 6-7 years, behind the baby teeth, and are often called six-year molars.
| Location | Upper dental arch, behind the second premolar on each side |
|---|---|
| Parts |
|
| Nerve Supply | Posterior superior alveolar nerve (maxillary division of the trigeminal nerve); Middle superior alveolar nerve to the mesiobuccal root when present; Greater palatine nerve (palatal gingiva) |
| Blood Supply | Posterior superior alveolar artery (from the maxillary artery) |
| Venous drainage |
|
| Lymphatic drainage |
|
Grind food and take much of the force of chewing; the first molars are also key to how the upper and lower teeth meet (molar relationship).
The mesiobuccal root very often holds a second canal (MB2), and missing it is a common cause of failed root canal treatment. The roots sit close to the floor of the maxillary sinus, so extraction can create an opening into the sinus and infection can cause one-sided sinusitis. The deep fissures are a classic site for decay in children and are protected with fissure sealants.
Decay in the deep occlusal fissures, often starting soon after the tooth erupts in childhood.
An opening between the mouth and the maxillary sinus after extraction, letting fluid pass into the nose.
A developmental enamel defect of the first permanent molars (and often incisors) giving soft, discoloured enamel that breaks down and decays quickly.
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