The best medicine for a toothache is ibuprofen, either alone or combined with acetaminophen. The American Dental Association’s clinical practice guideline recommends non-opioid pain relievers as first-line therapy for acute dental pain, and ibuprofen at 400 mg is the standard starting point. For more intense pain, combining 400 mg ibuprofen with 500 mg acetaminophen provides stronger relief than either drug alone.
Why Ibuprofen Works Best for Tooth Pain
Most toothaches involve inflammation inside or around the tooth. When bacteria reach the inner pulp of a tooth, the tissue swells, but because it’s trapped inside a hard shell, the pressure builds with nowhere to go. That pressure on the nerve is what causes the throbbing, intense pain characteristic of a toothache.
Ibuprofen targets this directly. It blocks the enzymes responsible for producing inflammatory chemicals in the dental pulp, including prostaglandin E2 and several other signaling molecules that amplify pain and swelling. In studies of patients with irreversible pulpitis (the clinical term for an inflamed, dying tooth nerve), taking 600 mg of ibuprofen one hour before dental treatment significantly reduced levels of multiple inflammatory markers inside the tooth. Acetaminophen, by contrast, reduces pain through the central nervous system but does little to calm the local inflammation driving the problem. That’s why ibuprofen generally outperforms acetaminophen for dental pain when used on its own.
The Ibuprofen-Acetaminophen Combination
For moderate to severe toothache pain, combining ibuprofen and acetaminophen attacks the problem through two different pathways simultaneously. The ADA’s guideline suggests either 400 mg ibuprofen alone or 400 mg ibuprofen paired with 500 mg acetaminophen as the go-to approach. Because the two drugs work through separate mechanisms, they amplify each other’s effects without increasing side effects the way doubling down on a single drug would.
You can take them at the same time or stagger them. A common approach is to take ibuprofen, then take acetaminophen a few hours later, alternating throughout the day. Just stay within the daily limits: no more than 3,200 mg of ibuprofen and no more than 3,000 mg of acetaminophen from all sources in 24 hours. That acetaminophen cap matters especially if you’re also taking a combination cold or flu product that contains acetaminophen, since those hidden doses add up fast.
How Quickly Pain Relievers Kick In
Ibuprofen typically starts working within 30 to 60 minutes of swallowing a tablet. Acetaminophen is slightly faster, with an onset around 30 to 45 minutes and peak effect within 30 minutes to an hour. If you’re in severe pain and need something to bridge the gap, a topical numbing gel containing benzocaine can provide relief in under four minutes. The tradeoff is that benzocaine only lasts about 20 to 30 minutes, so it’s a stopgap, not a solution.
Naproxen sodium (the active ingredient in Aleve) is another option the ADA lists alongside ibuprofen. It has a similar onset of 30 to 60 minutes but lasts longer, making it useful if you want fewer doses throughout the day. The suggested dose for dental pain is 440 mg.
If You Can’t Take Ibuprofen
Some people can’t use ibuprofen or other NSAIDs, including those with kidney disease, certain stomach conditions, a history of gastrointestinal bleeding, or those on blood thinners. If that’s you, the ADA guideline recommends acetaminophen alone at a full therapeutic dose of 1,000 mg per dose. While it won’t reduce the inflammation at the tooth, it still provides meaningful pain relief through its effects on pain signaling in the brain.
If acetaminophen alone isn’t enough, the guideline allows for adding a low-dose prescription opioid to acetaminophen as a backup. But even in that scenario, the recommendation is to use the lowest effective dose for the shortest possible duration, which rarely exceeds three days. Opioids are not first-line for dental pain, and studies consistently show the ibuprofen-acetaminophen combination performs comparably to or better than opioid combinations for most toothaches.
Clove Oil as a Natural Option
Clove oil contains eugenol, a compound dentists have used for over a century as both an antiseptic and a topical pain reliever. In a controlled study comparing a clove gel to 20% benzocaine gel, both produced significantly lower pain scores than placebo, and there was no measurable difference between the two. Clove oil is a reasonable choice if you want a natural alternative to benzocaine gel while waiting to see a dentist.
To use it, apply a small amount of clove oil to a cotton ball and hold it against the painful area. The taste is strong and the sensation can be intense for a moment before numbness sets in. Like benzocaine, the relief is temporary, so you’ll still want an oral pain reliever working in the background.
Why Antibiotics Won’t Help Most Toothaches
One of the most common misconceptions about toothaches is that antibiotics will fix the problem. They won’t, in most cases. ADA and CDC guidelines are clear: antibiotics are not needed for the urgent management of most dental pain and swelling in otherwise healthy adults. Pain from an inflamed or infected tooth requires definitive dental treatment, meaning a procedure like a root canal, extraction, or drainage. Antibiotics cannot reach the interior of a dead or dying tooth effectively, so they don’t resolve the underlying cause or meaningfully reduce pain.
Antibiotics do become appropriate in specific situations: when an abscess is accompanied by systemic signs like fever, facial swelling that’s spreading, or difficulty swallowing or breathing. They’re also indicated when definitive dental treatment isn’t immediately available and there’s an abscess with signs of infection spreading beyond the tooth. If your condition worsens, you develop swelling in the floor of your mouth or neck, or you feel generally unwell with a fever, that warrants urgent evaluation.
Dosing for Children
Children’s dosing is based on weight, not age. For acetaminophen, the standard range is 4 to 10 mg per kilogram of body weight every 6 to 8 hours, with a maximum single dose of 400 mg. For ibuprofen, it’s 10 to 15 mg per kilogram every 4 to 6 hours, up to 75 mg per kilogram per day (but never exceeding 4,000 mg). Naproxen is an option for children over age 2, dosed at 5 to 6 mg per kilogram every 12 hours.
Two important restrictions for children: codeine and tramadol are both contraindicated in kids under 12, per the FDA. And topical benzocaine should not be used in infants or young children due to the risk of methemoglobinemia, a serious condition where the blood loses its ability to carry oxygen effectively. Children’s liquid ibuprofen or acetaminophen, dosed by weight using the syringe that comes with the product, is the safest starting point.
Pain Medication Is a Bridge, Not a Fix
Every recommendation here is designed to manage pain temporarily. Ibuprofen, acetaminophen, clove oil, and benzocaine all buy you time, but none of them treat the cause. A cavity doesn’t heal on its own, an infected nerve won’t recover, and an abscess won’t drain itself. The pain may come and go as inflammation fluctuates, which can create the illusion that the problem resolved. It hasn’t. The underlying issue progresses whether or not it hurts on any given day, and infections that start in a tooth can spread into the jaw, the soft tissues of the face, and in rare cases, the bloodstream.