A child’s toothache usually needs a combination of pain relief, simple home care, and a dental visit to resolve the underlying cause. Most toothaches in children come from cavities, but they can also result from a cracked tooth, food stuck between teeth, or a new tooth pushing through the gums. Here’s how to manage the pain right now and know when the situation is more serious.
Give the Right Pain Reliever by Weight
The two safe over-the-counter options for children’s tooth pain are acetaminophen (Tylenol) and ibuprofen (Motrin, Advil). Ibuprofen is often more effective for dental pain because it reduces inflammation, but either one works. Dose by your child’s weight, not their age.
For acetaminophen, you can give a dose every 4 to 6 hours, up to 5 times in 24 hours. A child weighing 24 to 35 pounds gets 160 to 200 mg per dose. A child weighing 48 to 71 pounds gets 320 to 400 mg. For ibuprofen, doses are given every 6 to 8 hours, up to 4 times in 24 hours. A child weighing 24 to 35 pounds gets 100 to 125 mg, while a child weighing 48 to 71 pounds gets 200 to 250 mg. Check the concentration on the bottle carefully, since children’s liquid formulas vary.
Never give aspirin to a child under 12. Aspirin in children is linked to Reye’s syndrome, a rare but life-threatening condition that causes swelling in the liver and brain.
Products to Avoid
It’s tempting to reach for numbing gels like Orajel, Anbesol, or similar products that contain benzocaine or lidocaine. Don’t. The FDA warns that these products offer little benefit for children’s dental pain and carry serious risks, including a condition called methemoglobinemia, where the blood loses much of its ability to carry oxygen. This can be fatal. The warning applies to all benzocaine-containing oral products as well as homeopathic teething tablets.
Simple Home Remedies That Help
A cold pack on the outside of the cheek near the sore tooth can numb the area and bring down swelling. Wrap the pack in a cloth to protect the skin, and hold it on for 10 to 15 minutes at a time. You can repeat this as needed with breaks in between.
For children old enough to swish and spit without swallowing (usually around age 6), a warm saltwater rinse can ease gum irritation. Mix half a teaspoon of salt into 8 ounces of warm water. Have your child swish gently for 15 to 30 seconds and spit. This can be repeated several times a day. If half a teaspoon stings, you can reduce the amount of salt further.
Stick to soft foods and avoid anything very hot, cold, or sugary, which can trigger sharper pain. If your child is eating on one side to avoid the sore tooth, that’s fine for now.
Help Your Child Sleep Through the Pain
Toothaches almost always feel worse at night. When your child lies flat, blood flow to the head increases, which raises pressure around the tooth and intensifies throbbing. Prop their head up with an extra pillow or two so they’re sleeping at a slight incline. Giving a dose of pain reliever about 30 minutes before bedtime can also help them fall asleep before the next wave of discomfort hits.
Check Their Mouth Before Calling the Dentist
Before you call, take a quick look inside your child’s mouth with a flashlight. Ask them to point to where it hurts and describe what the pain feels like (sharp, dull, throbbing). Then look for:
- Red or swollen gums around a specific tooth
- Visible holes or dark spots on a tooth surface
- A cracked or chipped tooth
- Food or debris wedged between teeth (gently try dental floss)
- Sores or bumps on the gums, cheeks, or tongue
Noting how long the pain has lasted, what triggers it, and whether it’s constant or comes and goes gives the dentist useful information over the phone. They can often tell from your description whether your child needs to be seen that day or can wait for a regular appointment.
Signs That Need Urgent Attention
Most childhood toothaches are uncomfortable but not dangerous. A dental abscess, however, is an infection that can spread and become serious quickly. Get your child seen urgently if you notice any of these:
- Facial swelling, especially along the jaw or cheek
- Fever alongside tooth pain
- A pimple-like bump on the gum near the sore tooth
- Pain so severe they can’t open their mouth or eat
- A bad taste in their mouth, which can signal draining pus
If swelling spreads to the eye area, affects their vision, or makes it hard to breathe or swallow, that’s an emergency. Go to the emergency room rather than waiting for a dental office to open.
Why the Dentist Visit Still Matters
Home remedies and pain relievers manage symptoms, but they don’t fix the cause. Cavities are the most common reason children get toothaches, and a cavity only gets larger without treatment. What starts as mild sensitivity can progress to an infection that reaches the nerve or jawbone. Even if the pain goes away on its own after a day or two, that doesn’t always mean the problem resolved. Sometimes the nerve dies, and the pain stops temporarily before an abscess develops weeks later.
A pediatric dentist can identify the cause with an exam and, if needed, an X-ray. Treatment depends on what’s going on: a small cavity might need a filling, a deeper one might need a crown, and an infected tooth might need additional care to clear the infection. For baby teeth that are close to falling out naturally, the dentist may recommend a different approach than for permanent teeth. Getting your child in promptly means simpler, less stressful treatment in most cases.