The most effective over-the-counter option for a toothache is ibuprofen (400 mg) combined with acetaminophen (1,000 mg), taken together. Research from Case Western Reserve University found this combination outperformed even opioid-containing medications for dental pain. The American Dental Association recommends non-opioid pain relievers as first-line therapy for acute dental pain, with this combination or an NSAID alone as the starting point.
Why the Ibuprofen-Acetaminophen Combo Works Best
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces both pain and swelling at the source. Acetaminophen works differently, targeting pain signals in the brain. Because they act through separate pathways, combining them provides stronger relief than either one alone.
If you can’t take NSAIDs due to stomach issues, kidney problems, or other reasons, acetaminophen alone at 1,000 mg is the recommended alternative. Naproxen sodium (440 mg) is another NSAID option that lasts longer per dose, which can be helpful overnight. Avoid exceeding the daily limits listed on the packaging for any of these medications.
Topical Numbing Agents
Over-the-counter oral gels containing benzocaine can temporarily numb the area around an aching tooth. Apply a small amount directly to the gum near the pain. However, the FDA has issued warnings about benzocaine: it can cause a rare but serious condition called methemoglobinemia, which reduces the oxygen your blood can carry. Benzocaine products should never be used on children under 2 years old, and adults should follow label directions carefully and use them sparingly.
Clove oil is a natural alternative worth trying. It contains 70% to 90% eugenol, a compound that acts as a local anesthetic, anti-inflammatory, and antibacterial agent. To use it safely, dilute a few drops in a carrier oil like coconut or olive oil, dip a cotton ball or swab into the mixture, and hold it against the sore gum for a short time. Spit it out afterward rather than swallowing.
Salt Water Rinses
A warm salt water rinse is one of the simplest things you can do while waiting for medication to kick in. Mix 1 teaspoon of salt into 8 ounces of warm water and swish gently for 30 seconds. If that stings too much, cut the salt to half a teaspoon for the first day or two.
Salt water helps in several ways. It kills bacteria through osmosis, essentially pulling water out of bacterial cells and destroying them. It also shifts the mouth toward a more alkaline environment, which makes it harder for harmful bacteria to survive. If there’s swelling in the gums, salt water draws out excess fluid from infected tissue, reducing inflammation. It’s not a cure, but it can take the edge off and keep the area cleaner while you arrange professional care.
Cold Compresses for Swelling
If your cheek or jaw is swollen, hold an ice pack or cold compress against the outside of your face for 10 to 20 minutes at a time, with a thin cloth between the ice and your skin. This constricts blood vessels in the area and reduces both swelling and pain. You can repeat this throughout the day with breaks between sessions.
Sleeping With a Toothache
Toothaches often feel worse at night. When you lie flat, blood pools around your head and increases pressure on the inflamed tooth. A few adjustments can make a real difference:
- Elevate your head with two or more pillows, or sleep in a slightly upright position. Gravity helps reduce blood accumulation around the painful area.
- Sleep on the opposite side from the toothache so you’re not pressing your face into the pillow against the sore spot.
- Take your pain reliever about 30 minutes before bed so it’s working by the time you lie down.
What Your Pain Is Telling You
Not all toothaches are the same, and the type of pain you’re feeling signals what’s happening inside the tooth. Sensitivity to cold or sweets that fades quickly usually points to early-stage inflammation of the tooth’s inner tissue. At this stage, the problem is often reversible with a filling or other straightforward repair.
Pain that lingers for more than a few seconds after exposure to hot or cold, or a constant throbbing ache, suggests the inflammation has progressed further. At that point, the damage to the nerve tissue inside the tooth typically can’t heal on its own. Treatment usually means a root canal to remove the infected tissue, or in some cases, extraction. If the tooth stops being sensitive to temperature entirely but still hurts when you bite down, the nerve may have already died, and the tooth still needs treatment.
Signs You Need Urgent Care
Most toothaches warrant a dental appointment within a few days, but certain symptoms mean you shouldn’t wait. A fever combined with facial swelling suggests the infection may be spreading beyond the tooth. Swelling in your neck, tender lumps under your jaw, or difficulty breathing or swallowing are signs the infection has moved into deeper tissues. If you experience any of these and can’t reach a dentist, go to an emergency room. A dental infection that spreads into the jaw, throat, or neck can become dangerous quickly.
What Not to Do
Avoid placing aspirin directly on the gum next to a sore tooth. This is a common home remedy that can burn the soft tissue and cause more damage. Aspirin taken orally is also a less ideal choice than ibuprofen for dental pain because it thins the blood more aggressively, which can complicate bleeding if you end up needing a procedure.
Don’t rely on pain relievers as a long-term solution. Over-the-counter medications manage symptoms effectively for a few days, but a toothache almost always signals a problem that will progress without professional treatment. What starts as reversible inflammation can become an abscess or a dead nerve if left too long. The pain may even temporarily disappear as the nerve dies, which sometimes gets mistaken for the problem resolving itself.