Ibuprofen and naproxen are roughly equal at relieving tooth pain, but naproxen lasts significantly longer. In a head-to-head clinical trial of 203 patients after wisdom tooth extraction, the two drugs kicked in at about the same speed and provided comparable relief in the first few hours. By the 12-hour mark, naproxen pulled ahead with statistically superior pain control. That longer duration is the most meaningful difference between them for most people dealing with a toothache.
How They Compare in Clinical Trials
The most direct comparison comes from a double-blind study where patients received either naproxen sodium 220 mg, ibuprofen 200 mg, or a placebo after having impacted wisdom teeth removed. Both drugs beat placebo convincingly. From hours 1 through 12, naproxen showed a consistent trend toward better pain relief, though the gap was modest early on and only became statistically significant at 12 hours.
A large Cochrane review of naproxen for post-surgical dental pain found that a full dose (naproxen sodium 550 mg) gave at least 50% pain relief to the majority of patients, with an average duration of about 9 hours before people reached for another painkiller. Placebo patients needed rescue medication at just 2 hours. The review noted that naproxen’s combination of strong relief and long duration “compared favourably with other analgesics commonly used for postoperative pain.”
Ibuprofen at a standard 400 mg dose, taken every 6 hours, is also highly effective. Many dentists prescribe 600 mg every 6 to 8 hours for moderate to severe dental pain. The key trade-off: ibuprofen needs to be taken more frequently throughout the day, while naproxen covers a longer window per dose.
Why NSAIDs Work So Well for Tooth Pain
Tooth pain is driven by inflammation. When dental tissue is damaged or infected, your body produces signaling molecules called prostaglandins that sensitize nerve endings and amplify pain. Both ibuprofen and naproxen block the enzyme responsible for making those prostaglandins, which reduces swelling and turns down the pain signal at its source. They also suppress a key inflammatory pathway that activates genes involved in the immune response, essentially interrupting the chain reaction that makes inflamed dental tissue throb.
This is why the American Dental Association recommends NSAIDs as the first-line treatment for acute dental pain. They target the specific type of inflammation involved in toothaches more effectively than many other over-the-counter options.
Adding Acetaminophen for Severe Pain
If either drug alone isn’t enough, combining ibuprofen with acetaminophen (Tylenol) is a well-supported strategy. The two work through completely different mechanisms and don’t interact with each other, so taking them together is safe for most adults. In a randomized trial of post-surgical dental pain, combinations of ibuprofen (200 to 300 mg) with acetaminophen (500 mg) provided pain relief comparable to ibuprofen 400 mg alone, with some evidence of faster onset. You can alternate them or take them at the same time.
This combination is particularly useful for the first day or two after a procedure, or when a toothache is keeping you up at night.
Which One to Choose
Your choice comes down to convenience and your body’s tolerance. Naproxen is the better pick if you want fewer doses per day and longer overnight coverage. Taking it twice a day can keep pain controlled without setting alarms to re-dose. Ibuprofen is a better choice if you want more flexibility to adjust your dose up or down throughout the day, or if you’ve tolerated it well in the past and already have it in your medicine cabinet.
For pain after a dental procedure, many dentists recommend starting the medication before the local anesthetic wears off. One study found that taking ibuprofen 45 minutes before a procedure for an inflamed tooth nerve improved pain control and made the anesthesia work more effectively.
Side Effects and Safety Concerns
Both drugs carry the same core risks because they belong to the same class. The most common concern is stomach irritation. NSAIDs can erode the stomach lining over time, potentially causing ulcers or gastrointestinal bleeding, especially with prolonged use. Taking them with food helps.
More serious but less common risks include elevated blood pressure, kidney strain, and cardiovascular events like heart attack or stroke. These risks increase with longer use and higher doses. People with asthma should be cautious, as NSAIDs can trigger attacks in some individuals.
One specific interaction worth knowing: ibuprofen can interfere with low-dose aspirin if you take aspirin for heart protection. The FDA advises taking ibuprofen at least 30 minutes after your aspirin or at least 8 hours before it to avoid blunting aspirin’s blood-thinning effect. Neither NSAID should be used right before or after coronary artery bypass surgery.
Signs Your Tooth Pain Needs More Than Painkillers
Over-the-counter pain relief is a bridge, not a fix. A pimple-like bump on your gum, facial swelling, or fever can indicate an abscess, which is an infection that won’t resolve with painkillers alone. Bacteria from an untreated abscess can enter the bloodstream and spread to other organs. If your dentist can’t see you the same day, an emergency room can start antibiotics while you wait for dental care.
Pain that suddenly radiates to your neck and lower jaw deserves immediate attention for a different reason: it can mimic or actually be a symptom of a heart attack, particularly if you have known cardiovascular risk factors.