Molars are the largest teeth in the human mouth. They usually have two or more roots, and the large chewing surfaces make them ideal for chewing food. Normally, a person has 12 molars, but extraction is not unusual for the four third molars, or wisdom teeth, due to a lack of sufficient space for them to remain in the adult mouth. Maxillary molars lie near the maxillary sinus, and the mandibular molars lie in close proximity to the important mandibular nerve and artery. Severe molar tooth pain can interfere with normal daily activities and can also be difficult to diagnose.
Causes
Tooth decay is one of the primary causes of an abscessed tooth and a severe toothache, according to the Penn State Hershey Medical Center. When decay approaches or exposes the dental pulp, it creates inflammation of this soft tissue within a tooth. Severe inflammation results in an infection with pain and swelling. Other causes of this process include cracks, trauma and multiple dental procedures. First molar teeth are the first to erupt at around age 6 and hence become susceptible to these causes very early. Molars crack more frequently due to their chewing of hard foods. Inflammation or infection of the maxillary sinus can cause upper molar tooth pain because their roots often protrude through the base of the sinus cavity. Other body pains such as earaches, temperomandibular joint pain and even a heart attack can also refer pain to the molar teeth. Periodontal disease can create a gum infection that makes teeth ache and surrounding soft tissue swell, according to the American Academy of Periodontology.
Diagnosis
Correctly determining the source of pain is essential to proper treatment. A dentist makes a thorough visual examination of the tooth and surrounding soft tissues. Tooth decay and signs of infection in the bone adjacent to root surfaces are detectable on a dental radiography. An abscessed tooth is tender to tapping with a metal dental instrument, according to the American Academy of Family Physicians. Probing the gum surrounding a tooth for a pocket helps diagnose the presence of a gum infection. Referred pain from other body parts may require referral to a medical health professional.
Treatment
A severely inflamed or infected dental pulp causing a toothache requires removal of the pulp. Root canal treatment and tooth extraction are the two options for achieving this. According to the American Association of Endodontists, root canal treatment can save most abscessed teeth. This involves making a small opening through the tooth. Small root canal instruments remove the diseased pulp and clean the inside of the root. The placement of a root canal filling inside the root seals it from future infection. Cleaning the periodontal pocket in the gum alleviates most pain from a gum infection. Severe gum infections may require periodontal surgery. Pulpal and periodontal problems may require antibiotics and prescription pain medications.
Complications
Tooth extraction can solve the pain problem, but causes other dental problems unless replacement occurs as soon as possible. Although not preferred, extensive tooth decay or loss of surrounding bone may necessitate removal. Saving some teeth may not be possible due to a deep fracture. An abscessed tooth or gum can turn into cellulitis, which can compromise breathing ability, according to the American Academy of Family Physicians.
Prevention/Solution
Proper tooth-brushing, flossing and regular dental exams help prevent most toothaches. At the onset of any dental pain or swelling, see a dentist as soon as possible.
