From the Guidelines
For acute tooth pain without swollen gum or fever, the most effective treatment is to start with over-the-counter pain relievers like ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours), as these are the preferred long-term oral analgesics for pain management 1. When managing acute tooth pain, it's essential to consider the potential causes, such as cavities, cracks, or exposed roots, and to prioritize treatments that address both the symptoms and the underlying issue.
- Apply a cold compress to the outside of your cheek for 15-20 minutes to reduce pain and inflammation.
- Avoid consuming very hot, cold, or sweet foods and beverages that might trigger or exacerbate the pain.
- Rinse with warm salt water (1/2 teaspoon salt in 8 ounces warm water) several times daily to help clean the area and reduce bacterial load.
- Use clove oil applied with a cotton ball directly to the painful tooth for temporary numbing relief. It's crucial to schedule a dental appointment as soon as possible, as these temporary measures only manage symptoms, and the underlying cause requires professional treatment to prevent further complications, such as infection or abscess formation. If pain worsens significantly, spreads to your jaw or ear, or if swelling or fever develops, seek immediate dental care, as these could indicate a spreading infection that necessitates urgent attention 1.
From the FDA Drug Label
Temporarily relieves pain associated with the following mouth and gum irritations: toothache sore gums canker sores braces minor dental procedures The treatment for acute tooth pain without swollen gum or fever is benzocaine (TOP), which can temporarily relieve toothache pain 2.
- Key points:
- Relieves toothache pain
- For temporary use
- Applies to mouth and gum irritations, including toothache 2
From the Research
Treatment Options for Acute Tooth Pain
- For acute tooth pain without swollen gum or fever, the following treatment options are available:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are recommended as first-line therapy for managing acute dental pain 3, 4, 5, 6
- The use of opioids should be reserved for clinical situations when first-line therapy is insufficient or contraindications to NSAIDs exist 4, 5, 6
- A step-by-step plan based on the WHO analgesic ladder can be followed to effectively manage dental pain, starting with acetaminophen, then adding an NSAID, and finally adding a weak or strong opioid if necessary 3
Medication Options
- Acetaminophen and ibuprofen are commonly used medications for acute tooth pain, with a fixed-dose combination of the two providing greater and more rapid analgesia than either agent alone or placebo 7
- NSAIDs such as ibuprofen, diclofenac, and naproxen can be used alone or in combination with acetaminophen to manage acute dental pain 3, 4, 5, 6
- Opioids such as tramadol, morphine, and oxycodone can be used in certain clinical situations, but their use should be cautious and reserved for when first-line therapy is insufficient 3, 4, 5, 6
Special Considerations
- When prescribing analgesics to risk groups such as frail elderly, pregnant and lactating women, and children, attention is needed to ensure safe and effective use 3
- The use of codeine and tramadol in children for managing acute pain is contraindicated according to the US Food and Drug Administration 5