Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Toothache is the pain people describe as the worst they've had, and the internet's answer to it is a video promising to "kill the nerve in 3 seconds". There is no such trick. What there is: a painkiller combination that works better than most people realise, four home steps that take the edge off within the hour, and a clear line between the toothache that can wait for a dental appointment and the one that can't. Here's all of it.
What causes toothache?
Most toothache is the nerve inside a tooth reacting to something: decay that has reached the sensitive layer, a cracked tooth or a lost filling, an abscess (a pocket of infection at the root or in the gum, usually a throbbing pain with swelling and a bad taste), gum disease, a wisdom tooth pushing through, grinding, or plain sensitivity to hot, cold and sweet. Pain in the upper back teeth that started with a cold is often sinusitis pressing on the roots rather than the teeth at all. Whatever the cause, painkillers manage it; only a dentist fixes it.
Which painkiller is best for toothache?
Ibuprofen, because dental pain is inflammatory and ibuprofen treats the inflammation as well as the pain. Take 400mg (two standard tablets) with food, every six to eight hours, up to three times a day without advice. If that isn't enough, add paracetamol: 1g (two 500mg tablets) up to four times a day, at least four hours apart. Taken together, ibuprofen and paracetamol relieve dental pain better than either alone and better than codeine, which is why dentists recommend the pair. Nuromol puts both in one tablet. Aspirin works like ibuprofen but is harder on the stomach, and it must never be held against the tooth or gum; it burns the tissue. If you can't take ibuprofen (asthma triggered by anti-inflammatories, a stomach ulcer, kidney problems, pregnancy, blood thinners), paracetamol alone is the choice.
| Option | Adult dose | Notes |
|---|---|---|
| Ibuprofen | 400mg every 6 to 8 hours with food, max 1,200mg a day | First choice; best for throbbing, inflamed pain |
| Paracetamol | 1g every 4 to 6 hours, max 4g a day | Add to ibuprofen, or use alone if ibuprofen isn't suitable |
| Ibuprofen + paracetamol | Per pack | The combination in one tablet |
| Codeine combinations | Per pack, 3 days at most | Pharmacy medicine; adds little over the pair above and causes constipation and drowsiness |
Naproxen is a good anti-inflammatory for dental pain but the pharmacy pack is licensed only for period pain; a dentist can prescribe it. Everything above is in our pain relief range.
How to stop toothache fast at home
Four things, done together, while the painkillers get going. Salt water rinse: half a teaspoon of salt in a glass of warm water, swished round the sore area for 30 seconds and spat out, several times a day; it reduces bacteria and soothes inflamed gum, and it's what the NHS recommends first. Cold compress: a bag of frozen peas in a tea towel against the cheek for 15 to 20 minutes at a time numbs the area and reduces swelling; never put ice directly on the tooth. Clove oil: dab a drop of Bell's clove oil on a cotton bud and touch it to the sore tooth and the gum right beside it (the eugenol in it is a mild anaesthetic); don't flood the mouth with it, keep it off the tongue and lips, and don't use it in children. A numbing oral liquid or gel with lidocaine, such as Anbesol liquid, painted on the gum around the tooth gives 20 minutes or so of relief that can get you to sleep. Eat soft food on the other side, avoid very hot, cold or sugary things, keep brushing gently with a soft brush, and don't smoke, which makes dental pain worse. If a filling has fallen out, a temporary filling kit from a pharmacy can cover the exposed tooth until your appointment.
Why is toothache worse at night?
Lying flat sends more blood to the head and raises the pressure inside an already inflamed tooth, and there's nothing to distract you. Sleep with your head raised on two pillows, take a dose of ibuprofen and paracetamol together about half an hour before bed, and use the cold compress on the pillow side.
Wisdom tooth pain
Wisdom teeth come through between about 17 and 25, and the pain is usually the gum flap over a partly erupted tooth getting infected (pericoronitis) rather than the tooth itself. Salt water rinses, ibuprofen and a chlorhexidine mouthwash such as Corsodyl for a few days usually settle it; clean the area with a soft brush even though it hurts. See a dentist if there's swelling, pus, a bad taste, difficulty opening your mouth, or if it keeps flaring, because a tooth that repeatedly traps infection is usually removed.
Can toothache cause a headache or earache?
Yes. The nerve that supplies the teeth also supplies the jaw, ear and temple, so a bad tooth can ache into the ear or across one side of the head, and clenching against the pain adds a tension headache on top. If the "toothache" moves around, gets worse when you bend forward and came with a blocked nose, think sinusitis instead; a decongestant and the same painkillers help, and it settles as the cold does.
How long does toothache last, and when to see a dentist
Sensitivity from a small crack or a receding gum comes and goes for weeks; pain from decay or infection gets steadily worse and does not go away on its own, because the cause is still there. The NHS rule is simple: see a dentist if toothache lasts more than two days or isn't controlled by painkillers. If you don't have a dentist, call 111 or use the NHS "find a dentist" service for an urgent appointment; GPs can't treat teeth. Go to A&E if the swelling has spread to your eye or neck, you're finding it hard to breathe or swallow, you can't open your mouth, or you have a high temperature with a swollen face: those are signs of a spreading abscess, which is a genuine emergency. Antibiotics alone don't cure an abscess; it needs draining, so a course from a dentist is a bridge to treatment, not a substitute.
Frequently asked questions
Will paracetamol help toothache?
Yes, but ibuprofen helps more, and the two together help most. Use paracetamol alone only if ibuprofen isn't suitable for you.
Is naproxen good for toothache?
It's an effective anti-inflammatory for dental pain, but the pharmacy pack is licensed for period pain only, so it needs a prescription for teeth. Ibuprofen does the same job.
Can I use these painkillers if I'm pregnant?
Paracetamol, yes. Avoid ibuprofen in pregnancy unless a doctor advises it. Clove oil is best avoided too. Dental treatment is free on the NHS during pregnancy and for a year after the birth, so book in.
Will antibiotics fix toothache?
Only when there is a spreading infection, and even then as a stopgap: an abscess needs draining or root treatment, and antibiotics do nothing for pain from decay, a crack or a lost filling. Dentists prescribe them for swelling and fever, not for pain alone.
How long can I take ibuprofen for toothache?
Up to 10 days at the pack dose, with food, if you are otherwise well. But toothache that still needs painkillers after two days belongs at the dentist, not back at the pharmacy counter.