What Is the Best Pain Relief for a Toothache?

Ibuprofen, taken alone or combined with acetaminophen (paracetamol), is the most effective over-the-counter pain relief for a toothache, and the research behind that answer is surprisingly strong. Multiple randomized trials and systematic reviews have converged on the same conclusion: a nonsteroidal anti-inflammatory drug outperforms acetaminophen by itself, outperforms opioid-containing medications, and works even better when the two non-opioid drugs are paired. But the best pain relief also depends on your situation, because pregnancy, childhood, and certain medical conditions change the calculus.

Why Ibuprofen Beats Acetaminophen on Its Own

When researchers have pitted ibuprofen directly against acetaminophen in controlled trials, ibuprofen consistently comes out ahead. In a randomized, double-blind study of acute pain, ibuprofen at 400 mg provided greater peak pain relief, longer duration of action, and better overall patient evaluations than acetaminophen at 1,000 mg.¹ That result makes sense when you consider what each drug does. Ibuprofen is an anti-inflammatory: it tackles both pain signaling and the swelling that often drives dental pain in the first place. Acetaminophen dampens pain perception but does little for inflammation. Since toothache usually involves inflamed pulp tissue or surrounding gum, having that anti-inflammatory action matters.

That said, the gap between the two drugs is not always dramatic. One trial looking specifically at pain after orthodontic tooth movement found no statistically significant difference between ibuprofen and acetaminophen at their peak.² Orthodontic soreness is generally milder than the acute pain of a badly decayed or infected tooth, so the context matters. For moderate-to-severe toothache, ibuprofen’s edge is more pronounced.

Combining Ibuprofen and Acetaminophen

If ibuprofen alone is good, ibuprofen plus acetaminophen is better. Because the two drugs work through different pathways, taking them together produces additive pain relief without doubling down on the same set of side effects. A randomized trial of dental surgery patients found that ibuprofen 400 mg paired with paracetamol 1,000 mg gave significantly better pain scores than either drug alone.³ Even a lower-dose combination (ibuprofen 200 mg with paracetamol 500 mg) outperformed paracetamol alone, though it did not clearly beat ibuprofen on its own.

A review in the Journal of the American Dental Association confirmed this pattern across several randomized controlled trials: the ibuprofen-acetaminophen combination delivered greater pain relief than either drug used by itself after third-molar extractions.⁴ A separate pair of studies looking at a fixed-dose combination product found it beat both individual components and placebo, with pain relief lasting more than eight hours and the combination being generally well tolerated.⁵

In practical terms, this means you can alternate or stagger the two drugs. A common approach is to take ibuprofen, then take acetaminophen a couple of hours later, and keep rotating. Because ibuprofen and acetaminophen are processed differently by the body, this schedule keeps pain relief more consistent than re-dosing either drug alone. You are not exceeding the safe dose of either one as long as you stay within each drug’s label limits.

Opioids Are Not the Answer for Most Dental Pain

For decades, dentists routinely prescribed opioid-containing painkillers for toothaches and post-procedure pain. That practice has shifted substantially. A large overview of systematic reviews published in the Journal of the American Dental Association found that NSAIDs, with or without acetaminophen, provided pain relief equal to or better than opioid-containing medications for dental pain.⁶ The harms side of the ledger tilts even more decisively: opioids carry risks of nausea, constipation, sedation, and the well-documented potential for dependence.

Despite this evidence, opioids are still prescribed more often than they should be, particularly in emergency department settings. A study of Medicaid and commercially insured patients who visited an ED for a dental condition found that roughly 40% filled an opioid prescription within a week of the visit.⁷ Emergency departments typically cannot perform the definitive dental work that actually resolves the pain, so the visit becomes a bridge to care elsewhere, often with prescriptions that are not the best first-line option.

Antibiotics Will Not Fix Your Toothache

One of the most persistent misconceptions about toothache is that antibiotics will make the pain go away. They won’t. A Cochrane systematic review found that antibiotics did not significantly reduce toothache caused by irreversible pulpitis, which is the inflamed, dying nerve inside a tooth that causes the classic throbbing pain. Patients who received penicillin used just as many pain pills as those who received a placebo, and there was no meaningful difference in pain perception or sensitivity to tapping on the tooth.⁸

This makes sense if you think about what antibiotics do: they fight bacteria, not inflammation or nerve irritation. When the pulp inside your tooth is irreversibly inflamed, the problem is tissue that needs to be physically treated (with a root canal or extraction), not an infection that bacteria-killing drugs can resolve on their own. Antibiotics have a role in dental care when there is a spreading infection, facial swelling, or fever, but they are not pain relievers. Yet the same ED study cited above found that about 55% of patients filled antibiotic prescriptions after dental-related emergency visits,⁷ suggesting the practice remains widespread even when the evidence does not support it.

Topical Products and Home Remedies

When you are waiting for ibuprofen to kick in, topical options can take the edge off. Over-the-counter gels containing benzocaine numb the gum tissue around the sore tooth and provide temporary relief. Benzocaine is generally safe when used as directed for short periods, but it carries a rare risk: it can cause methemoglobinemia, a condition where hemoglobin loses its ability to deliver oxygen effectively to tissues.⁹ This risk is small in adults using the product briefly, but it is worth knowing about, especially for children under two, in whom benzocaine-containing products are not recommended.

Clove oil is the folk remedy with the most pharmacological credibility. The active ingredient, eugenol, is actually used in professional dental materials and has documented analgesic properties. Animal studies have shown that clove extracts produce measurable pain-reducing effects, and that these effects are at least partly mediated through opioid-receptor pathways in the nervous system.¹⁰ In practice, dabbing a small amount of clove oil on a cotton ball and holding it against the painful area can produce temporary numbing. The evidence is not as robust as what we have for ibuprofen, but it is not snake oil either.

Ice can also help. A study found that ice massage on the hand (specifically the web of skin between the thumb and index finger) reduced the intensity of dental pain by half or more in most patients, and did so more effectively than simple touch or suggestion alone.¹¹ Applying a cold compress to the outside of the cheek near the sore tooth is a more conventional approach that works through basic vasoconstriction and numbing of the area. Neither method replaces medication, but both can supplement it.

When You Are Pregnant or Treating a Child

Pregnancy complicates pain management because the drugs that work best are not universally safe for the developing fetus. Acetaminophen is considered appropriate for mild to moderate pain during pregnancy. NSAIDs like ibuprofen can be used in the first and second trimesters, but should be avoided in the third trimester because of established risks including premature closure of a fetal heart structure called the ductus arteriosus.¹² If you are in your third trimester with a severe toothache, acetaminophen alone or a short course of a weaker opioid under medical supervision may be the realistic options while you arrange definitive dental treatment.

For children, an evidence-based guideline from the American Dental Association recommends NSAIDs (ibuprofen or naproxen) alone or combined with acetaminophen for managing acute dental pain. The guideline specifically notes that the U.S. Food and Drug Administration considers the use of codeine and tramadol contraindicated in children for acute pain management.¹³ The doses differ from adult doses and should be weight-based, so checking the label carefully or calling the pediatrician first is worth the extra minute. Aspirin is off the table entirely for children due to the risk of Reye’s syndrome.

What Definitive Treatment Looks Like

Pain medication is a bridge, not a destination. The best pain relief for a toothache, in the long run, is fixing whatever is causing it. When the problem is irreversible pulpitis, that means either a root canal procedure (pulpectomy) or, in some cases, a partial nerve removal (pulpotomy). A randomized clinical trial comparing the two approaches found that both effectively eliminated pain: preoperative pain scores averaged about 5.8 on a 10-point scale and dropped to around 1.3 within 72 hours. Patient satisfaction scores averaged above 9 out of 10 for both groups.¹⁴

Getting numb in the first place can be tricky when a tooth is badly inflamed, because acidic tissue from the infection can reduce the effectiveness of local anesthetics. This is where the choice of anesthetic matters. Multiple meta-analyses have found that articaine is more effective than lidocaine for dental anesthesia, and the difference is especially pronounced in inflamed teeth. One systematic review found articaine had roughly twice the odds of achieving successful anesthesia compared to lidocaine overall.¹⁵ Another meta-analysis focusing on patients with irreversible pulpitis found articaine had a success rate about 1.4 times greater than lidocaine for lower teeth.¹⁶ If you have ever had a dentist struggle to get you numb on an acutely painful tooth, it is worth knowing that articaine exists and asking about it.

When a Toothache Is Not Really a Tooth Problem

Sometimes the pain feels exactly like a toothache but the teeth are perfectly healthy. Conditions that can mimic dental pain include jaw muscle problems (myofascial pain), trigeminal neuralgia, headache disorders that refer pain to the face, sinus disease, and even cardiac pain.¹⁷ This is not a rare scenario: it is common enough that researchers have written specifically about preventing unnecessary dental extractions and root canals performed on the wrong diagnosis. If your dentist examines the teeth, takes X-rays, and finds nothing wrong, that is not the end of the road. It is the beginning of a different diagnostic path.

Sinus infections are probably the most frequent impersonator. The roots of your upper back teeth sit very close to the floor of the maxillary sinus, so when that sinus is inflamed, the sensation can feel identical to a toothache on multiple upper teeth. The giveaway is usually that the pain affects several teeth at once rather than one, and it worsens when you bend over. In that case, treating the sinus problem resolves the “toothache” without any dental work at all.

Managing Anxiety and Pain Together

Fear and anxiety amplify pain perception. If you dread dental visits, that dread does not just make you uncomfortable in the waiting room — it measurably increases the pain you feel during and after procedures. A randomized trial found that music therapy during surgical extraction of impacted wisdom teeth led to significantly lower pain intensity after the procedure compared to standard care. Virtual reality distraction also reduced anxiety and stabilized blood pressure and heart rate.¹⁸ These are not replacements for anesthesia or analgesics, but they illustrate a useful principle: anything that reduces your stress level before and during dental treatment can reduce the pain you experience. Bringing headphones and a calming playlist to a dental appointment is free and evidence-backed.

People Who Cannot Take NSAIDs

Ibuprofen and other NSAIDs are not safe for everyone. People with a history of stomach ulcers, kidney disease, or uncontrolled high blood pressure need to be cautious, because NSAIDs can worsen all three conditions. People taking blood thinners should also avoid ibuprofen unless their doctor clears it, since the combination raises bleeding risk. And as noted above, pregnant people in their third trimester should not take NSAIDs.

If ibuprofen is off the table, acetaminophen alone is the next best option. It is gentler on the stomach and kidneys, and it does not interact with blood thinners in the same way. The trade-off is weaker pain control, especially for inflammatory dental pain. Acetaminophen has its own ceiling, though: the liver processes it, and exceeding the recommended daily maximum (typically 3,000 to 4,000 mg for adults, depending on the country’s guidelines) risks serious liver damage. That limit drops further if you drink alcohol regularly. Sticking within the recommended doses is more important with acetaminophen than with almost any other over-the-counter drug, because the gap between a therapeutic dose and a dangerous one is relatively narrow.

For people who cannot take either drug, the options narrow considerably. A dental visit becomes more urgent rather than less, because relying on topical numbing agents alone is not sustainable for more than a day or two. Prescription alternatives exist but require a clinician’s involvement to weigh the risks.

The Emergency Department Problem

If you have a severe toothache on a Friday night and your dentist’s office is closed, the emergency room might feel like your only option. But ED visits for dental pain tend to produce poor outcomes for a specific reason: emergency physicians generally cannot perform definitive dental treatment. They can prescribe pain medication and sometimes antibiotics, then refer you to a dentist. The result, as the data show, is a high rate of antibiotic and opioid prescribing for conditions where neither drug is the best choice.⁷ The visit addresses the symptom temporarily but does not fix the cause, and you still need the dentist on Monday.

Urgent-care dental clinics and dental school emergency clinics, where they exist, are a better alternative because they can actually treat the tooth. Some areas also have dental hotlines that can help triage whether you need same-day care or can safely manage at home until a regular appointment. If you do end up in an ED, knowing that ibuprofen plus acetaminophen is likely more effective than whatever opioid you might be offered gives you a basis for that conversation with the emergency physician.

1
PubMed. Ibuprofen and acetaminophen in the relief of acute pain: a randomized, double-blind, placebo-controlled study
2
PubMed. Comparison of the efficacy of ibuprofen and acetaminophen in controlling pain after orthodontic tooth movement
3
Clinical Therapeutics. Comparison of the analgesic efficacy of concurrent ibuprofen and paracetamol with ibuprofen or paracetamol alone in the management of moderate to severe acute postoperative dental pain
4
PubMed. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice
5
The Clinical Journal of Pain. Efficacy and Safety of Single and Multiple Doses of a Fixed-dose Combination of Ibuprofen and Acetaminophen in the Treatment of Postsurgical Dental Pain
6
The Journal of the American Dental Association. Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews
7
PubMed Central. Antibiotic and opioid prescribing for dental-related conditions in emergency departments: United States, 2012 through 2014
8
PubMed Central. Antibiotic use for irreversible pulpitis
9
PubMed Central. Benzocaine-Induced Methemoglobinemia: A Case Report
10
PubMed Central. Analgesic effect of the aqueous and ethanolic extracts of clove
11
PubMed Central. Relief of dental pain by ice massage of the hand
12
PubMed. Medication Use and Pain Management in Pregnancy: A Critical Review
13
The Journal of the American Dental Association. Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in children
14
PubMed Central. Pulpectomy vs. Pulpotomy as Alternative Emergency Treatments for Symptomatic Irreversible Pulpitis
15
PubMed. Does Articaine Provide an Advantage over Lidocaine in Patients with Symptomatic Irreversible Pulpitis? A Systematic Review and Meta-analysis
16
PubMed Central. Efficacy of 4% articaine vs 2% lidocaine in mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis: a systematic review and meta-analysis
17
PubMed. Differential diagnosis of toothache to prevent erroneous and unnecessary dental treatment
18
PubMed. Effect of virtual reality and music therapy on anxiety and perioperative pain in surgical extraction of impacted third molars