A tooth infection causes some of the most intense pain you’ll experience, and it tends to get worse at night. The fastest relief comes from combining two common over-the-counter pain relievers, but several other strategies can bring the pain down while you wait to see a dentist. Here’s what actually works.
The Most Effective Pain Reliever Combination
The American Dental Association’s 2024 clinical practice guideline recommends over-the-counter pain relievers as the first-line treatment for tooth infection pain, specifically ibuprofen taken alone or combined with acetaminophen. This combination outperforms either drug on its own because the two medications reduce pain through different pathways: ibuprofen targets inflammation at the infection site, while acetaminophen works on pain signaling in the brain.
A combination tablet (125 mg ibuprofen and 250 mg acetaminophen) is available over the counter, taken as two tablets every eight hours with a maximum of six tablets per day. If you don’t have the combination product, you can take standard ibuprofen and acetaminophen separately at their usual doses. The key is that they’re safe to take together because they’re processed differently in the body.
The ADA guideline is clear that these non-opioid options should be used instead of opioid painkillers, not as a backup to them. Opioids are reserved for rare cases where someone can’t take either ibuprofen or acetaminophen, and even then, they’re limited to three days or fewer.
Why Antibiotics Won’t Stop the Pain
If you’re hoping a course of antibiotics will make the throbbing stop, the evidence is disappointing. The ADA recommends against prescribing antibiotics for most dental pain and intraoral swelling from pulp and periapical infections in otherwise healthy adults. Antibiotics don’t reach the dead tissue inside an infected tooth effectively, and they don’t relieve pain the way anti-inflammatory medications do. The infection itself needs to be physically treated by a dentist, either through drainage, a root canal, or extraction. Antibiotics play a supporting role only when the infection has spread beyond the tooth into surrounding tissues or when someone has a compromised immune system.
Home Strategies That Help Right Now
Cold Compress on Your Cheek
Place ice or a cold pack against the outside of your cheek near the painful tooth for 10 to 20 minutes at a time, with a thin cloth between the ice and your skin. Cold reduces swelling in the tissue around the infection and numbs the nerve signals traveling from the area. You can repeat this throughout the day with short breaks between sessions. Do not apply heat to a tooth infection. Warmth increases blood flow to the area and can make swelling and pressure worse.
Saltwater Rinse
Dissolve one teaspoon of salt in eight ounces of warm water and swish gently around the affected area. If your mouth is especially tender, start with half a teaspoon for the first day or two. Saltwater draws fluid out of swollen tissue through osmosis, which temporarily reduces pressure on the nerve. It also helps clear bacteria from around the tooth. You can rinse several times a day, particularly after eating.
Clove Oil
Clove oil contains a natural compound called eugenol that acts as an anesthetic, temporarily numbing the nerve in an infected tooth. It also has antibacterial and anti-inflammatory properties. To use it, dab a small amount onto a cotton ball and hold it against the painful tooth for a minute or two. Keep it away from your gums as much as possible. Clove oil is safe for occasional use, but repeated application can irritate or damage gum tissue and the soft lining of your mouth, because eugenol is toxic to human cells at high concentrations.
Sleeping With a Tooth Infection
Tooth infections are notoriously worse at night, and that’s not your imagination. When you lie flat, blood flow to your head and mouth increases, which raises pressure around the infected tooth and amplifies pain. The simplest fix is to sleep in a slightly elevated position. Prop yourself up with an extra pillow or two so your head stays above your heart. This uses gravity to reduce blood pooling around the aching tooth and promotes drainage of the inflamed area. Taking your pain reliever about 30 minutes before bed also helps you fall asleep before the medication wears off. Avoid eating anything hot, cold, or acidic close to bedtime, since the exposed nerve in an infected tooth reacts sharply to temperature and acidity.
What Not to Do
One of the most common mistakes is placing an aspirin tablet directly against the gum next to a painful tooth. Aspirin’s full chemical name is acetylsalicylic acid, and that acid component causes chemical burns on the soft tissue of your gums and inner cheeks. It won’t cure the toothache, and it will leave you with a painful, white or raw patch of burned tissue on top of the original problem. Aspirin works on pain only after you swallow it and it enters your bloodstream.
Avoid poking at the infected area with toothpicks, pins, or your fingers. If there’s a visible abscess (a swollen bump on the gum), don’t try to pop or drain it yourself. You risk pushing bacteria deeper into the tissue or introducing new bacteria from your hands. Similarly, avoid very hot or very cold foods and drinks. The nerve inside an infected tooth is often partially exposed, and extreme temperatures cause sharp, shooting pain that can linger for minutes.
Signs the Infection Is Spreading
A tooth infection that stays localized is painful but manageable in the short term while you arrange dental care. An infection that spreads beyond the tooth into your jaw, neck, or bloodstream is a medical emergency. Go to an emergency room if you develop a fever, rapid heart rate, rapid breathing, confusion or disorientation, low blood pressure, difficulty breathing, or swelling that moves from your jaw into your neck or under your eye. These are signs of sepsis, a life-threatening response to infection entering the bloodstream. Swelling that makes it difficult to open your mouth or swallow is also an emergency, because it can progress to block your airway.
Facial swelling that’s getting visibly larger over hours rather than days also warrants urgent care, even without the symptoms listed above. A dental infection won’t resolve on its own. Pain management buys you time, but the infection needs professional treatment to actually clear.