How to manage a 7-year-old child's nocturnal toothache without immediate access to a dentist?

From the Guidelines

For a 7-year-old child with a nighttime toothache without immediate dental access, give children's acetaminophen (Tylenol) or ibuprofen (Motrin) at age-appropriate doses following the package instructions, as this is the most effective way to manage the pain temporarily. For a 7-year-old weighing about 50 pounds, this is typically 160mg of acetaminophen or 100mg of ibuprofen 1. Have the child rinse with warm salt water (1/2 teaspoon salt in 8 ounces of water) to reduce inflammation. Apply a cold compress to the outside of the cheek for 15-20 minutes to reduce swelling and numb the area. Clove oil can provide temporary relief when applied with a cotton ball directly to the painful tooth. Keep the child's head elevated with extra pillows while sleeping to reduce blood flow to the head and minimize throbbing pain. Avoid hot, cold, sweet, or acidic foods and beverages that could worsen the pain.

These measures work by reducing inflammation, blocking pain signals, and temporarily numbing the affected area. While these steps provide temporary relief, schedule a dental appointment as soon as possible, as tooth pain indicates a problem requiring professional treatment. According to the American Board of Pediatric Dentistry, all children should have a Dental Home within 6 months of the eruption of the first tooth, and a pediatric patient who presents with any of the following conditions should be referred for prompt consultation to a pediatric dentist or a general dentist who maintains a high level of competence in the care of children 1. Referral to a dentist or an oral surgeon is recommended for dental trauma in a primary care setting 1.

Some key points to consider when managing a child's toothache include:

• Using a validated age-appropriate pain scale, such as the Wong-Baker FACES scale or the FLACC postoperative pain tool, to assess the child's pain level 1
• Providing education on how to assess pain and achieve adequate pain management utilizing pharmacologic and nonpharmacologic interventions 1
• Considering nonpharmacologic pain management strategies, such as relaxation, distraction, imagery, cold or heat application, touch, massage, eating, drinking, chewing gum, emotional support, and creating a comfortable environment that minimizes noise 1
• Referring the child to a pediatric dentist or a general dentist who maintains a high level of competence in the care of children if the child presents with any conditions that require prompt consultation 1.

From the Research

Managing a 7-year-old child's nocturnal toothache without immediate access to a dentist

• The American Dental Association recommends the use of nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen for the temporary management of toothache in children 2, 3.
• NSAIDs such as ibuprofen and naproxen are considered first-line therapy for managing acute dental pain in children, with a more favorable safety profile compared to opioids 2, 3, 4.
• Acetaminophen can also be used to manage acute dental pain, and its combination with caffeine may be effective in achieving good control of acute dental pain 5.
• Topical anesthetics such as benzocaine may provide rapid pain relief for toothache, with an average analgesic onset time of 111.8 seconds 6.
• It is essential to follow the recommended dosage and administration guidelines for any medication, and to consult with a dentist or healthcare professional as soon as possible for proper evaluation and treatment.

Medication options

• Ibuprofen: 10-15 mg/kg every 6-8 hours as needed, not to exceed 40 mg/kg per day 2.
• Acetaminophen: 10-15 mg/kg every 4-6 hours as needed, not to exceed 75 mg/kg per day 2.
• Benzocaine: apply topically to the affected area as directed, usually 3 drops 6.

Important considerations

• Always read and follow the label instructions for any medication.
• Consult with a dentist or healthcare professional before giving any medication to a child.
• If the child's toothache persists or worsens, seek immediate dental attention.
• Opioids should not be used to manage acute dental pain in children, as they can have serious side effects and are not recommended by the American Dental Association 2, 3, 4.