The best medicine for a toothache is ibuprofen and acetaminophen taken together. This combination outperforms either drug alone and, according to a systematic review published in The Journal of the American Dental Association, even beats many prescription opioid-containing painkillers for dental pain while causing fewer side effects.
Why the Combination Works So Well
Ibuprofen and acetaminophen attack pain through different pathways, which is why pairing them is more effective than doubling up on one. Ibuprofen is an anti-inflammatory. Most toothache pain comes from swelling and pressure inside or around the tooth, and ibuprofen directly reduces that inflammation by blocking the chemicals your body produces in response to damage. Acetaminophen works differently: it dulls the pain signal itself in your brain without doing much for inflammation. Together, they hit the problem from both ends.
For adults, the standard approach is 400 mg of ibuprofen plus 500 mg of acetaminophen every six to eight hours. You can also buy a combined tablet (sold under the brand name Advil Dual Action) containing 125 mg ibuprofen and 250 mg acetaminophen per tablet, taken as two tablets every eight hours. Don’t exceed six of these combined tablets in 24 hours.
If You Can Only Take One
Not everyone can safely take both. If you need to choose one, ibuprofen is generally the stronger option for tooth pain because inflammation is usually a major part of the problem. A typical dose is 200 to 400 mg every four to six hours. Naproxen is another anti-inflammatory option that lasts longer, so you only need to take it every 12 hours (220 mg per dose for OTC strength).
If you have stomach ulcers, kidney problems, or are on blood thinners, anti-inflammatories may not be safe for you. In that case, acetaminophen alone (500 to 1,000 mg every six to eight hours) is the better choice. It won’t reduce swelling, but it will take the edge off the pain.
Safety Limits That Matter
The biggest risk with acetaminophen is liver damage, and the danger is easier to stumble into than most people realize. The maximum safe amount is 4,000 mg in 24 hours, but many cold medicines, flu remedies, and sleep aids already contain acetaminophen as a hidden ingredient. If you’re taking anything else from your medicine cabinet, check the label for “acetaminophen” or “APAP” before adding more. Exceeding the daily limit has been linked to acute liver failure.
Anti-inflammatories like ibuprofen and naproxen carry their own risks. They can irritate the stomach lining and affect kidney function, especially with prolonged use. Taking them with food helps reduce stomach upset. If you have heart disease, these medications also carry a small increased risk of cardiovascular events, so keep the dose as low as possible and use them for as short a time as needed.
Managing a Child’s Toothache
For children, dosing should be based on weight rather than age. Both acetaminophen and ibuprofen are safe for kids, but the amounts are very different from adult doses. Ibuprofen can be given to infants six months and older at 10 to 15 mg per kilogram of body weight every four to six hours. Acetaminophen follows a similar weight-based approach at 4 to 10 mg per kilogram every six to eight hours.
As a rough guide for ibuprofen: a child weighing 24 to 35 pounds gets about 100 mg per dose, while a child weighing 48 to 59 pounds gets about 200 mg. Children’s liquid suspensions come with measuring syringes for this reason. A few things to avoid: topical benzocaine gels (like Orajel) should not be used on infants or young children because they carry a risk of a serious blood condition called methemoglobinemia. Codeine and tramadol are contraindicated in children under 12.
What Else Helps While You Wait
Medication works best when you pair it with a few simple measures. Rinsing with warm salt water (half a teaspoon of salt in eight ounces of water) can reduce bacteria and ease gum swelling. A cold compress held against the outside of your cheek for 15 to 20 minutes at a time can numb the area and reduce inflammation. Sleeping with your head slightly elevated helps prevent blood from pooling around the tooth, which can make throbbing pain worse at night.
Avoid very hot, very cold, or sugary foods and drinks, as these can trigger or worsen the pain. If the toothache is caused by a cavity or crack, chewing on the opposite side of your mouth reduces direct pressure on the damaged tooth.
Signs You Need Emergency Care
Over-the-counter pain relief is a temporary bridge, not a fix. The underlying cause of a toothache, whether it’s a cavity, infection, cracked tooth, or gum disease, needs professional treatment. If the pain doesn’t improve after two or three days of medication, or it’s getting progressively worse, that’s a signal the problem is advancing.
Some symptoms require immediate attention. Difficulty breathing, swallowing, or opening your mouth can indicate a spreading infection. Swelling that moves into your eye, neck, or floor of your mouth is a medical emergency. Fever combined with facial swelling often points to a dental abscess, which can become dangerous if the infection reaches deeper tissues. In these situations, go to an emergency room rather than waiting for a dental appointment.