Ibuprofen (Advil, Motrin) is the single most effective over-the-counter medicine for a toothache. A Cochrane review of high-quality evidence found ibuprofen outperformed acetaminophen at every dose studied, based on both pain relief scores and how often patients needed additional medication. But the best strategy isn’t choosing one or the other. It’s using both together.
Why Ibuprofen Works Best for Tooth Pain
Most toothaches involve inflammation, whether from a cavity reaching the nerve, a cracked tooth, or an infection at the root. Ibuprofen is an anti-inflammatory, so it targets the source of the pain rather than just blocking pain signals in the brain. That’s why it consistently beats acetaminophen in dental pain studies. Acetaminophen relieves pain but does nothing to reduce the swelling and inflammation that make a toothache throb.
A standard dose is 400 mg (two regular-strength tablets). Take it with water and some food to protect your stomach. You can repeat this dose every six hours as needed, up to 1,200 mg in a day when self-treating.
The Combination That Works Better Than Either Alone
The American Dental Association recommends combining ibuprofen and acetaminophen for dental pain. This approach works because the two medications reduce pain through completely different pathways, so their effects stack rather than overlap. The recommended combination is 400 mg of ibuprofen (two tablets) plus 500 mg of acetaminophen (one extra-strength tablet), taken together and repeated throughout the day as needed.
If you’re dealing with pain after a dental procedure, take the first dose about an hour after the procedure or before the numbing fully wears off. Staying ahead of the pain is far more effective than chasing it once it’s already intense. Take each dose with a full glass of water and some soft food.
Naproxen as a Longer-Lasting Alternative
Naproxen sodium (Aleve) is another anti-inflammatory option that works well for dental pain. In a clinical study comparing a single 440 mg dose of naproxen sodium to 1,000 mg of acetaminophen after dental implant surgery, naproxen was significantly more effective at controlling pain during both the initial hours and the days that followed. It also provided a longer duration of relief per dose.
The practical advantage of naproxen is convenience. You take it every 8 to 12 hours instead of every 4 to 6, which means fewer doses to remember, especially overnight. The tradeoff is that it takes a bit longer to kick in than ibuprofen. If you need fast relief right now, ibuprofen is the better first choice. If you want something that carries you through the night, naproxen may be more useful.
Don’t combine naproxen with ibuprofen. They’re in the same drug class and using both increases stomach and kidney risks without adding pain relief. You can, however, combine naproxen with acetaminophen the same way you would with ibuprofen.
Topical Options for Targeted Relief
Oral gels containing benzocaine (like Orajel) numb the gum tissue directly around the painful tooth. They work fast, usually within a minute or two, and can take the edge off while you wait for an oral pain reliever to kick in. Apply a small amount directly to the sore area. The relief is temporary, typically lasting 20 to 30 minutes, so think of these as a supplement rather than a primary treatment.
Clove oil is a natural alternative that contains eugenol, a compound with both numbing and anti-inflammatory properties. A clinical trial in a French emergency dental unit found eugenol was actually more effective than a prescription local anesthetic at reducing pain from severe tooth inflammation. To use it, apply a small amount to a cotton ball and hold it against the affected tooth for 5 to 10 minutes. You can reapply every 2 to 3 hours. The taste is strong and not for everyone, but the pain relief is real.
Who Should Avoid Ibuprofen
Ibuprofen and naproxen belong to a class called NSAIDs, and they aren’t safe for everyone. If you have kidney disease, NSAIDs can cause further damage. Mayo Clinic guidance is clear: people with kidney disease should not take ibuprofen, naproxen, or aspirin for pain relief. Acetaminophen is the safe alternative in this case.
You should also avoid NSAIDs if you have a history of stomach ulcers or gastrointestinal bleeding, or if you’re taking blood thinners. People with uncontrolled high blood pressure or heart failure should be cautious as well, since NSAIDs can raise blood pressure and cause fluid retention.
Acetaminophen is gentler on the stomach and kidneys, but it has its own ceiling. The absolute maximum is 4,000 mg per day, though staying at or below 3,000 mg is safer, especially with regular use. The bigger risk with acetaminophen is that it shows up in dozens of other products like cold medicines, sleep aids, and combination pain relievers. It’s easy to accidentally double up if you’re not reading labels.
Managing Toothaches in Children
For children under 12, the ADA recommends acetaminophen or ibuprofen as first-line treatments for dental pain, either alone or in combination. Both are safe and effective when dosed appropriately for the child’s weight. The doses printed on OTC packaging are a good starting point, but a dentist or pediatrician may recommend slightly different amounts depending on the child’s situation.
Never give aspirin to children or teenagers, as it’s linked to a rare but serious condition called Reye’s syndrome. Benzocaine gels should also be avoided in children under two years old.
When OTC Medicine Isn’t Enough
Over-the-counter pain relievers are a bridge, not a cure. They manage symptoms while the underlying problem still needs professional treatment. If your pain persists beyond a couple of days, is severe enough that maximum OTC doses barely take the edge off, or comes with visible swelling in your face or jaw, you’re likely dealing with something that won’t resolve on its own.
Certain symptoms signal a genuine emergency. Fever combined with facial swelling, difficulty breathing, or trouble swallowing can indicate that a dental infection has spread beyond the tooth into the jaw, throat, or neck. That situation requires an emergency room visit, not another dose of ibuprofen.