The best medicine for a toothache is ibuprofen combined with acetaminophen, taken together. This combination is the first-line recommendation in the American Dental Association’s 2024 clinical practice guideline, and clinical evidence shows it works as well as or better than opioid painkillers for acute dental pain.
Why the Combination Works Better Than Either Alone
Ibuprofen and acetaminophen relieve pain through completely different mechanisms. Ibuprofen reduces inflammation at the source of the pain, which is especially useful for toothaches since most dental pain involves inflamed tissue or nerve irritation. Acetaminophen works centrally, changing how your brain processes pain signals. When you take both, they produce a synergistic effect, meaning the combined relief is greater than what you’d get by simply adding their individual effects together.
For moderate dental pain, the recommended approach is ibuprofen (400 to 800 mg every six hours) plus acetaminophen (500 to 650 mg every six hours, or 1,000 mg every eight hours). You can take them at the same time. A combination tablet is also available over the counter, containing 125 mg ibuprofen and 250 mg acetaminophen per tablet, dosed at two tablets every eight hours. If you’re buying them separately, you have more flexibility to adjust the dose within safe limits.
This combination consistently matches or outperforms prescription opioid painkillers in clinical comparisons for dental pain, without the risks of dependence, nausea, or sedation that come with opioids. The ADA now explicitly recommends reserving opioids only for cases where this first-line approach isn’t enough.
If You Can Only Take One
Not everyone can take both medications. If you need to choose just one, ibuprofen is generally more effective for toothaches because dental pain almost always involves inflammation. Acetaminophen doesn’t reduce inflammation, so it treats the pain signal without addressing what’s driving it.
However, ibuprofen isn’t safe for everyone. You should stick with acetaminophen alone if you have stomach ulcers or a history of gastrointestinal bleeding, kidney disease, or if you’re already taking blood thinners. Acetaminophen is gentler on the stomach and kidneys but has a strict ceiling: no more than 4 grams (4,000 mg) per day for adults, and less if you drink alcohol regularly, since both stress the liver.
Topical Options for Targeted Relief
While oral painkillers work through your bloodstream, topical numbing agents act directly on the sore area and can provide additional relief, especially while you’re waiting for pills to kick in.
Benzocaine gel (sold as Orajel and similar brands at 20% concentration) numbs the gum tissue on contact. Clove oil, which contains a natural compound called eugenol, works similarly. In a controlled trial with 73 volunteers, a clove-based gel and 20% benzocaine gel produced statistically identical pain reduction, both significantly better than placebo. The main difference: a small number of participants (4 out of 73) developed minor mouth sores from the clove gel, and both products caused a brief burning sensation during application.
To use clove oil, dab a small amount onto a cotton ball and hold it against the painful area. For benzocaine gel, apply a pea-sized amount directly to the gum around the affected tooth. Neither product treats the underlying problem, but they can take the edge off while your oral medication is working.
Toothache Medicine for Children
The same two medications, ibuprofen and acetaminophen, are recommended for children’s dental pain, but dosing is based on weight rather than age. Acetaminophen is dosed at 10 to 15 mg per kilogram of body weight, given every four to six hours, with a daily maximum of 75 mg per kilogram for children two and older. Ibuprofen is dosed at 5 to 10 mg per kilogram every six to eight hours, up to 40 mg per kilogram per day.
Ibuprofen is typically avoided in babies younger than six months. For infants under that age, acetaminophen alone is the standard choice. Children’s liquid formulations come in specific concentrations, so read the label carefully rather than estimating from adult tablets. The ADA’s 2023 guideline for children and adolescents mirrors the adult recommendation: nonopioid medications first, with the combination of an anti-inflammatory plus acetaminophen as the preferred approach.
One important safety note: benzocaine products should not be used in children under two years old due to the risk of a rare but serious blood condition.
When Pain Signals Something Serious
Over-the-counter painkillers manage the symptom, not the cause. A toothache that persists beyond a day or two, or one that keeps getting worse despite medication, usually means something is happening that needs professional treatment, whether that’s a deep cavity, a cracked tooth, or an infection.
A dental abscess is the scenario that can turn dangerous. If your toothache comes with any of the following, you need emergency care rather than another dose of ibuprofen:
- Fever of 100.4°F (38°C) or higher
- Swelling in your face or jaw
- Difficulty swallowing
- Rapid heart rate
- Confusion or feeling disoriented
These symptoms suggest the infection may be spreading beyond the tooth, and antibiotics (not just painkillers) become necessary. Facial swelling that’s visibly progressing, especially if it’s near your eye or throat, warrants an emergency room visit rather than waiting for a dental appointment.
Getting the Most From Your Pain Relief
Timing matters. Take ibuprofen with food or a glass of milk to protect your stomach lining, especially if you’re taking the higher end of the dose range. If you’re alternating doses rather than taking both at once, stagger them so you always have some level of pain coverage. For example, you could take ibuprofen, then three hours later take acetaminophen, and continue rotating.
Cold compresses on the outside of your cheek (20 minutes on, 20 minutes off) can reduce swelling and provide additional numbing. Avoid applying heat, which can increase blood flow to the area and make inflammatory pain worse. Sleeping with your head slightly elevated can also reduce throbbing, since lying flat increases blood pressure to your head.
These measures buy you time, but a toothache is your body telling you something structural is wrong. The medication handles the pain while you get to the real fix.