The most effective over-the-counter medicine for a toothache is ibuprofen and acetaminophen taken together. This combination outperforms either drug alone and, according to a systematic review published in the Journal of the American Dental Association, even beats many prescription opioid-containing painkillers for dental pain, with fewer side effects.
Why the Combination Works Best
Ibuprofen reduces inflammation, which is the main driver of most tooth pain. Acetaminophen blocks pain signals through a different pathway. Because they work in two distinct ways, taking them together produces stronger relief than doubling up on either one alone. This isn’t just theory: multiple randomized controlled trials after wisdom tooth extractions found the combination provided greater pain relief than ibuprofen or acetaminophen taken individually.
The American Dental Association now recommends this combination as a first-line approach for acute dental pain in adults and adolescents, placing it ahead of opioid-based options.
How to Take Ibuprofen and Acetaminophen Together
You can buy these as separate pills or as a single combination tablet. The combination tablet contains 125 mg of ibuprofen and 250 mg of acetaminophen per tablet. The standard adult dose is two tablets every eight hours as needed, with a maximum of six tablets per day.
If you’re using separate pills, a common approach is 400 mg of ibuprofen with 500 mg of acetaminophen every six to eight hours. Don’t exceed 1,200 mg of ibuprofen or 3,000 mg of acetaminophen in a 24-hour period. Take ibuprofen with food to protect your stomach. If you drink alcohol regularly or have liver concerns, be cautious with acetaminophen and stick to lower doses.
If You Can Only Take One
Ibuprofen on its own is the stronger choice for most toothaches because dental pain almost always involves inflammation, whether from an infected nerve, a cracked tooth, or swollen gums. A standard dose is 200 to 400 mg every four to six hours.
Acetaminophen is a reasonable backup if you can’t take ibuprofen, for instance if you have stomach ulcers, kidney problems, or are on blood thinners. It won’t reduce swelling, but it does help with pain. The typical adult dose is 500 to 1,000 mg every six hours.
Naproxen sodium is another option. It works similarly to ibuprofen but lasts longer, so you take it less often. The ADA lists a starting dose of 440 mg with a maximum of 1,100 mg per day. It’s a good choice if you want longer stretches of relief overnight.
Topical Options for Targeted Relief
Numbing gels and natural alternatives can help while you wait for oral painkillers to kick in, or as an extra layer of relief on top of them.
Benzocaine gel (sold as Orajel and similar brands) numbs the area on contact. Apply a small amount directly to the sore spot on your gum. It works within a few minutes but wears off relatively quickly. Avoid using it repeatedly in large amounts, and don’t use benzocaine products on children under two years old.
Clove oil is the classic home remedy, and it holds up to scrutiny. A study testing clove gel against 20% benzocaine gel found no significant difference in pain relief between the two. Clove contains a natural compound called eugenol, which dentists have used for decades as both a painkiller and antiseptic. You can dab a small amount of clove oil onto a cotton ball and press it against the painful tooth. A few participants in the study developed small mouth ulcers from the clove gel, and both clove and benzocaine can cause a brief burning sensation on application.
Toothache Relief for Children
Children’s ibuprofen is the go-to for kids with toothaches, but the dose depends on weight, not age. Liquid formulations come in two concentrations (infant drops at 50 mg per 1.25 mL and children’s liquid at 100 mg per 5 mL), so always check the label carefully. A child weighing 24 to 35 pounds, for example, would get 5 mL of children’s liquid ibuprofen. Kids 48 pounds and over can typically take a single adult 200 mg tablet.
Do not give ibuprofen to babies under six months old. For children under two or weighing less than 12 pounds, check with a pediatrician first. Never give aspirin to children or teenagers for pain relief.
What Not to Do
Placing aspirin directly on your gum next to a sore tooth is an old folk remedy that can burn the tissue and make things worse. Ice applied directly to the tooth can intensify pain if the nerve is exposed. Hold a cold pack against the outside of your cheek instead, 15 to 20 minutes at a time, to help with swelling.
Avoid very hot, very cold, or sugary foods and drinks, which can trigger sharp pain spikes in an already irritated tooth. If you’re dealing with a cavity or crack, chewing on the opposite side reduces pressure on the damaged area.
When a Toothache Needs Emergency Care
Over-the-counter pain relief is a bridge, not a cure. The underlying cause, whether it’s decay, infection, or a fracture, needs professional treatment. Some situations can’t wait for a routine appointment. If you have a fever along with facial swelling, the infection may be spreading beyond the tooth into your jaw or neck. Difficulty breathing or swallowing alongside tooth pain is a sign to go to an emergency room immediately, as this can indicate the infection has reached your throat or airway. Swelling that’s visibly spreading, pain that doesn’t respond at all to medication, or a foul taste from a draining abscess all warrant urgent dental care.