The best pain reliever for a toothache is ibuprofen (Advil, Motrin), either on its own or combined with acetaminophen (Tylenol). The American Dental Association recommends this non-opioid approach as the first-line treatment for acute dental pain in adults, and the combination outperforms either drug alone.
The specific dose that works best: 400 mg of ibuprofen (two standard pills) taken together with 500 mg of acetaminophen (one extra-strength pill). This pairing attacks tooth pain from two directions, reducing inflammation at the source while also blocking pain signals in the brain.
Why the Combination Works Better
Tooth pain is almost always driven by inflammation, whether from a cavity reaching the nerve, an infection, or a cracked tooth. Ibuprofen is an anti-inflammatory, so it directly targets the swelling and pressure inside the tooth or surrounding gum tissue. Acetaminophen works differently, acting on pain processing in the brain rather than at the site of injury. Together, they cover more ground than either one alone.
The ADA’s 2024 clinical practice guideline specifically recommends starting with an NSAID like ibuprofen (400 mg) or naproxen sodium (440 mg), alone or paired with 500 mg acetaminophen. Opioid painkillers are not recommended as a first option for dental pain.
If You Can’t Take Ibuprofen
Some people need to avoid ibuprofen and other NSAIDs entirely. This includes people with stomach ulcers, kidney disease, certain heart conditions, or those on blood thinners. If that’s you, acetaminophen alone is the backup option. The ADA suggests a full therapeutic dose of 1,000 mg (two extra-strength pills) for adults who can’t use NSAIDs.
Keep your total acetaminophen intake under 4,000 mg in any 24-hour period. Going over that threshold risks liver damage. If you drink three or more alcoholic drinks a day, your safe limit is lower, and you should talk to a pharmacist about what’s appropriate.
Ibuprofen carries its own risks. It can cause stomach bleeding, especially if you’re over 60, smoke, drink regularly, or have had ulcers in the past. Taking it with food helps reduce stomach irritation.
Naproxen for Overnight Relief
Toothaches famously get worse at night, partly because lying down increases blood flow to your head and partly because there’s nothing to distract you. If you’re struggling to sleep, naproxen sodium (Aleve) has an advantage over ibuprofen: it lasts longer.
In a clinical trial comparing the two after oral surgery, naproxen provided significantly better pain relief than ibuprofen at the 8- to 12-hour mark. The median time before patients needed additional medication was 7 hours with naproxen versus 6 hours with ibuprofen. That extra duration can be the difference between sleeping through the night and waking up in pain at 3 a.m. A single 440 mg dose (two Aleve pills) before bed is a reasonable approach, and you can still combine it with acetaminophen.
Topical Options for Immediate Relief
While you’re waiting for oral painkillers to kick in (usually 20 to 40 minutes), a topical numbing agent applied directly to the sore area can bridge the gap. Benzocaine gels like Orajel, typically at 20% concentration, are the most common over-the-counter choice. You dab a small amount onto the gum tissue around the painful tooth, and it numbs the area within a few minutes.
Clove oil is a natural alternative that performs surprisingly well. It contains eugenol, a compound widely used in dentistry for both pain relief and antiseptic properties. In a controlled study, clove gel produced pain scores statistically equal to 20% benzocaine, with both significantly outperforming placebo. To use it, soak a small cotton ball in clove oil and hold it against the sore spot. The taste is strong but the relief is real.
Pain Relief for Children
For kids with toothaches, the ADA recommends ibuprofen as the first choice, just as with adults. Children’s liquid ibuprofen or chewable tablets, dosed by weight according to the package, are preferred over acetaminophen alone because the anti-inflammatory effect matters for dental pain. If ibuprofen alone isn’t enough, adding acetaminophen is the next step.
A few important safety notes for children. Codeine and tramadol are contraindicated in kids under 12. Topical benzocaine should not be used on infants or young children because it carries a risk of a serious blood condition called methemoglobinemia, which reduces the blood’s ability to carry oxygen. Naproxen is FDA-approved only for children 12 and older, though some dentists may recommend it for younger children on a case-by-case basis.
When Tooth Pain Needs Emergency Care
Pain relievers are a temporary bridge. They manage symptoms while you wait to see a dentist, but they don’t fix the underlying problem. Most toothaches stem from decay, infection, or damage that requires professional treatment.
Certain signs mean you shouldn’t wait for a routine appointment. Swelling in your jaw or face, fever, swollen lymph nodes, or pain when opening your mouth all suggest an infection that may be spreading. If swelling is severe enough to make breathing or swallowing difficult, that’s a hospital emergency. The same goes for uncontrollable bleeding or pain so intense it prevents you from eating, sleeping, or functioning normally. A dental abscess left untreated can become dangerous quickly, so facial swelling combined with fever is a combination to take seriously.