If you have a toothache, the most effective immediate step is taking 400 mg of ibuprofen (two standard pills) together with 500 mg of acetaminophen (one extra-strength pill). This combination is recommended by the American Dental Association and works as well as prescription painkillers for most dental pain. Beyond that first dose, what you do next depends on how severe your symptoms are and what’s causing the pain.
Managing Pain at Home Right Now
The ibuprofen-acetaminophen combination works because the two drugs target pain through different pathways. Ibuprofen reduces inflammation at the source, while acetaminophen blocks pain signals in your brain. You can repeat this dose every six hours as needed. If you only have one of the two, ibuprofen alone is generally more effective for dental pain than acetaminophen alone because most toothaches involve inflammation.
A warm saltwater rinse can provide additional relief. Mix one teaspoon of table salt into eight ounces of warm water, swish it around the painful area for 30 seconds, then spit. Salt water draws fluid out of swollen tissue and helps clear bacteria from around the tooth. You can repeat this several times a day.
Clove oil is one home remedy with real science behind it. The oil is 70% to 90% eugenol, a compound that acts as a natural anesthetic, anti-inflammatory, and antibacterial agent. Dab a few drops onto a cotton ball and hold it against the painful tooth for a few minutes. It won’t fix the underlying problem, but it can numb the area noticeably while you wait to get professional care.
A cold compress on the outside of your cheek, 20 minutes on and 20 minutes off, helps reduce swelling and dulls nerve signals. Avoid putting aspirin directly on your gum tissue, a common folk remedy that actually burns the soft tissue and makes things worse.
What’s Likely Causing the Pain
Toothaches have a short list of usual suspects. A cavity that’s reached the inner nerve of the tooth is the most common cause of sharp, persistent pain. Cracked teeth often produce a stabbing pain when you bite down. Gum disease causes a duller, more widespread ache, sometimes with bleeding when you brush. Grinding your teeth at night can leave you with soreness that peaks in the morning and fades throughout the day.
Temperature sensitivity tells you something useful. If cold triggers a brief zing that disappears in seconds, you likely have early enamel erosion or a small cavity. If hot liquids cause lingering pain that takes minutes to subside, the nerve inside the tooth is probably inflamed or dying, which typically means you’ll need more than a simple filling.
Signs of a Dental Infection
A toothache that throbs constantly, wakes you up at night, or comes with visible swelling likely involves an abscess. There are two types: one forms at the tip of the tooth’s root from an untreated cavity, and the other forms in the gum tissue from trapped bacteria in the space between tooth and gum. Both produce pus, and you may notice a bad taste in your mouth or a small pimple-like bump on your gum.
An untreated abscess at the root of a tooth can spread to your jaw and eventually to other areas of your head and neck. In rare cases, the infection enters the bloodstream and causes sepsis, a life-threatening condition. This isn’t something that takes months to happen. A dental infection can escalate within days.
When to Go to the Emergency Room
Most toothaches need a dentist, not an ER. But certain symptoms mean you should go immediately:
- Facial swelling that’s spreading, especially toward your eye, under your jaw, or down your neck
- Difficulty swallowing or breathing, which signals the infection is compressing your airway
- Fever with dental pain, indicating the infection has become systemic
- Swollen lymph nodes in your neck paired with general feelings of illness
- Uncontrolled bleeding that makes you feel faint
What a Dentist Will Actually Do
The treatment depends entirely on the cause. A straightforward cavity gets a filling, which takes about 30 minutes and costs $50 to $250 depending on the material. Composite (tooth-colored) fillings run $90 to $250, while traditional silver amalgam fillings cost $50 to $150.
If the decay has reached the nerve, you’ll need a root canal. The procedure removes the infected tissue inside the tooth, and despite its reputation, modern root canals feel similar to getting a filling done. An incisor root canal typically costs $500 to $1,000, while a molar root canal runs $800 to $1,500. Most root-canaled teeth also need a crown afterward, adding another $600 to $2,000 depending on the material.
When a tooth is too damaged to save, extraction is the remaining option. A simple extraction costs $75 to $250. Surgical extractions, for teeth that are broken below the gum line or otherwise complicated, range from $180 to $550. If you want to replace the extracted tooth with an implant later, expect a total cost of $3,100 to $5,800 for the implant, connector piece, and crown combined.
Toothaches During Pregnancy
Pregnancy increases the risk of dental problems because of hormonal changes that make gums more vulnerable to inflammation and bacteria. If you’re pregnant and have a toothache, don’t assume you have to wait until after delivery. Dental X-rays are considered safe at any stage of pregnancy. Local anesthesia, including formulas with epinephrine, is also safe.
Pain medication is more complicated. The FDA hasn’t issued definitive recommendations on over-the-counter pain relievers during pregnancy because the available research is limited. Your best path is coordinating between your dentist and your OB-GYN to decide what’s appropriate for your specific situation and trimester. One thing to avoid: nitrous oxide (laughing gas) is classified as a pregnancy risk and is not recommended.
Helping a Child With a Toothache
Children’s ibuprofen is the go-to for pediatric dental pain, dosed by your child’s weight as listed on the package. For home remedies, the saltwater rinse works well for kids old enough to swish and spit without swallowing (usually around age six). Use the same ratio: one teaspoon of salt in eight ounces of warm water.
A cooled peppermint tea bag placed between the cheek and gum can act as a soothing compress. Peppermint oil on a cotton ball works too, but avoid peppermint extract, which has a high alcohol content that can irritate a child’s mouth. Clove oil is effective for children with severe pain, but use only a few drops on a cotton swab and don’t leave it in place for more than a few minutes. Never use whole or ground cloves.
Baby teeth with cavities still need treatment. An infected baby tooth can damage the permanent tooth developing beneath it, and the pain alone is reason enough to get it looked at promptly.
Getting Through the Night
Toothaches famously get worse at night. When you lie flat, blood pressure increases in your head, putting more pressure on the inflamed tissue around the tooth. Sleeping propped up on two or three pillows reduces this effect noticeably. Take your ibuprofen and acetaminophen dose right before bed so you have the full window of relief ahead of you. Keep the saltwater rinse on your nightstand for middle-of-the-night flare-ups.
Avoid very hot, very cold, or sugary food and drinks until you can get to a dentist. If you can identify which side the pain is on, chew exclusively on the opposite side. These measures won’t fix anything, but they stop you from repeatedly aggravating the problem while you wait for proper treatment.