The single most effective thing you can take for a toothache is ibuprofen combined with acetaminophen. This combination outperforms every other option, including prescription opioids, and is the first-line recommendation from the American Dental Association as of its 2024 clinical practice guideline. If you can only take one, ibuprofen alone is the better choice over acetaminophen alone because it reduces both pain and the inflammation driving most toothaches.
Why the Ibuprofen-Acetaminophen Combo Works Best
Ibuprofen and acetaminophen relieve pain through completely different pathways. Ibuprofen blocks inflammation at the source of the injury, while acetaminophen works higher up in the pain-signaling chain. Taking both at the same time means you’re interrupting the pain signal at two separate points, which produces stronger relief than either pill alone.
A large clinical trial of 1,815 adults found that 400 mg of ibuprofen combined with 500 mg of acetaminophen managed pain better than a hydrocodone-acetaminophen prescription for the first two days after tooth extraction. Patients on the over-the-counter combo also reported higher overall satisfaction: 85% were satisfied or extremely satisfied, compared to 79% of those taking the opioid. A broader review of data covering more than 58,000 patients confirmed the same pattern. The ibuprofen-acetaminophen combination beat every opioid-containing regimen tested and caused fewer side effects.
Both medications kick in within 30 to 60 minutes and last four to six hours per dose. You can take two doses together initially, then repeat every six to eight hours. A combined tablet is now available over the counter (250 mg acetaminophen plus 125 mg ibuprofen per tablet, two tablets per dose, up to six tablets per day), or you can simply take standard single-ingredient versions together.
If You Can Only Take One Medication
Ibuprofen at 400 mg is the stronger standalone choice for a toothache. Most tooth pain involves inflamed tissue, whether from a cavity, a crack, or an infection, and ibuprofen directly reduces that inflammation. Acetaminophen does not. If your pain is mild or you need something gentler on your stomach, acetaminophen (500 to 1,000 mg) still helps, but expect less relief.
Naproxen sodium is another option in the same anti-inflammatory family as ibuprofen. Its advantage is longer duration: up to 7 to 12 hours per dose versus 4 to 6 for ibuprofen. It’s a reasonable choice if you need overnight relief without waking up to re-dose. Do not combine naproxen with ibuprofen, though. They work through the same mechanism, and doubling up increases side-effect risk without meaningful extra benefit. You can, however, combine naproxen with acetaminophen.
Who Should Avoid Ibuprofen
Ibuprofen and other anti-inflammatory drugs aren’t safe for everyone. Long-term or frequent use raises the risk of stomach problems ranging from nausea to serious bleeding, especially if you’re older, smoke, drink alcohol regularly, or have a history of ulcers. These drugs can also reduce the effectiveness of blood pressure medications and diuretics, so if you take either of those, acetaminophen is the safer pain reliever for dental flare-ups.
People with kidney disease should be cautious as well, since anti-inflammatory drugs affect kidney function. If any of these apply to you, acetaminophen alone is still effective for pain and carries a lower risk profile for short-term use.
Salt Water Rinses
A warm salt water rinse won’t replace medication, but it’s a useful addition. Salt temporarily shifts the pH in your mouth toward alkaline, which makes the environment hostile to bacteria. It also draws moisture out of swollen tissue, which can reduce pressure and ease throbbing pain around an infected or irritated tooth.
The standard recipe is one teaspoon of salt dissolved in eight ounces of warm water. Swish gently for 30 seconds, then spit. If your mouth is very tender, start with half a teaspoon for the first day or two. You can repeat this several times a day.
Cold Compresses for Swelling
If your cheek or jaw is swollen, a cold pack applied to the outside of your face helps reduce both swelling and pain. Use it for 10 to 20 minutes at a time with a thin cloth between the ice and your skin, then give your skin a break before reapplying. This is especially helpful in the first day or two of a flare-up, or after any dental procedure.
Signs Your Toothache Needs More Than Pain Relief
Over-the-counter medication manages the pain, but it doesn’t treat the underlying problem. A toothache that persists more than a day or two usually means something is happening that requires dental treatment, whether that’s a deep cavity, a cracked tooth, or an abscess.
Certain symptoms signal that an infection may be spreading beyond the tooth itself. Fever, general fatigue or feeling unwell, facial swelling that’s getting worse, or swollen lymph nodes under your jaw all indicate systemic involvement. At that point, antibiotics become necessary in addition to pain management. Antibiotics alone, without treating the tooth, won’t resolve the problem, but they’re critical for containing an infection that’s moved beyond the local area.