The best painkiller for a toothache is ibuprofen combined with acetaminophen, taken together. This combination outperforms either drug on its own and, according to research published in The Journal of the American Dental Association, even works better than many prescription opioid-containing painkillers for dental pain. The American Dental Association recommends NSAIDs like ibuprofen as the first-line treatment for acute dental pain, and adding acetaminophen on top boosts the effect without increasing side effects.
Why the Combination Works Better
Ibuprofen and acetaminophen relieve pain through completely different mechanisms. Ibuprofen reduces inflammation at the source of the pain, while acetaminophen acts on pain signaling in the brain. Because they work on separate pathways, taking them together produces stronger relief than doubling down on either one alone.
Multiple randomized controlled trials on patients after wisdom tooth extraction found that the ibuprofen-acetaminophen combination provided greater pain relief than either drug individually. The side effects were no worse than taking each drug by itself, which makes this a safer escalation strategy than reaching for a prescription painkiller.
How to Take Them Together
You can take standard over-the-counter doses of both at the same time. A typical approach is 400 mg of ibuprofen (two regular tablets) plus 500 to 1,000 mg of acetaminophen (one or two extra-strength tablets). Both drugs start working within 30 to 60 minutes.
For ongoing toothache pain, you can alternate doses every few hours, but stay within daily limits. The maximum safe daily dose of ibuprofen is 3,200 mg, while acetaminophen should stay under 3,000 mg per day from all sources. That second limit matters because acetaminophen hides in many cold medicines, sleep aids, and other combination products. Check the labels of everything you’re taking.
If You Can Only Take One
Not everyone can safely take both drugs. If you need to pick just one, ibuprofen is the stronger choice for dental pain because toothaches almost always involve inflammation, and ibuprofen targets that directly. It’s available over the counter in 200 mg tablets, and you can take up to two or three at a time for more intense pain.
Naproxen sodium (sold as Aleve) is another NSAID option. It works similarly to ibuprofen but lasts longer, roughly 8 to 12 hours per dose, which can be useful for getting through the night. The trade-off is a lower daily ceiling of 1,100 mg, so you have less room to adjust your dose upward.
Acetaminophen alone is a reasonable backup if you can’t take any NSAIDs. It won’t reduce inflammation, so it’s less effective for most toothaches, but it still dulls the pain signal and kicks in within 30 to 45 minutes.
Who Should Avoid NSAIDs
Ibuprofen and naproxen aren’t safe for everyone. You should stick with acetaminophen alone if you have a history of stomach ulcers or gastrointestinal bleeding, kidney disease, or are in the third trimester of pregnancy. People on blood thinners also need to be cautious, since NSAIDs can increase bleeding risk. If you take daily aspirin for heart protection, ibuprofen can interfere with aspirin’s effects when taken at the same time.
Acetaminophen carries its own risk: liver damage at high doses. If you drink alcohol regularly or have any liver condition, the safe threshold drops considerably. Staying under 3,000 mg per day provides a margin of safety for most adults.
Topical Numbing Gels
Over-the-counter gels containing benzocaine (like Orajel) can temporarily numb the area around a painful tooth. They work fast, within a minute or two, but the relief is short-lived and superficial. The FDA has issued safety warnings about benzocaine products, noting they can cause a rare but life-threatening condition called methemoglobinemia, where the blood’s ability to carry oxygen drops dangerously. This risk is highest in children under 2 (benzocaine should never be used for them) but can occur in adults as well.
If you use a benzocaine gel, apply it sparingly and treat it as a bridge to get through the worst moments, not as your main pain strategy. The combination of ibuprofen and acetaminophen will do more for sustained relief.
What the Pain Is Telling You
Over-the-counter painkillers manage the symptom, not the cause. A toothache that lasts more than a day or two typically signals decay that has reached the nerve, a crack in the tooth, or an infection forming at the root. Painkillers buy you time, but the underlying problem will progress without dental treatment.
Certain symptoms indicate a dental infection that’s spreading and needs urgent attention. If you develop a fever along with facial swelling, that combination warrants an emergency room visit if you can’t see a dentist right away. Difficulty breathing or swallowing is even more serious, as it can mean the infection has moved into the throat or neck. These situations are rare, but they escalate quickly.
Getting Through the Night
Toothaches notoriously worsen at night. Lying flat increases blood flow to your head, which amplifies throbbing pain. Propping yourself up with an extra pillow can help. Taking your ibuprofen-acetaminophen combination about 30 minutes before bed gives it time to reach full effect. A cold compress on the outside of your cheek, 15 minutes on and 15 off, can reduce swelling and numb the area slightly. Rinsing gently with warm salt water (half a teaspoon of salt in eight ounces of water) can also ease discomfort, especially if there’s swelling in the gums around the tooth.