What medication is recommended for a toothache?

Medication Management for Toothache

For toothache pain, ibuprofen at a dose of 400mg every 4-6 hours as needed is the recommended first-line medication due to its superior analgesic efficacy and favorable safety profile compared to other over-the-counter options. 1

First-Line Treatment Options

Ibuprofen (Preferred)

• Dosage: 400mg every 4-6 hours as needed for pain
• Maximum daily dose: Do not exceed 3200mg in 24 hours
• Mechanism: Provides both analgesic and anti-inflammatory effects
• Evidence: Ibuprofen 400mg has consistently demonstrated superior efficacy compared to aspirin 650mg, acetaminophen 600mg, and combinations of these with codeine 2
• Administration: Take with food or milk to minimize gastrointestinal side effects 1

Alternative: Acetaminophen (Paracetamol)

• Dosage: 500-1000mg every 6 hours as needed
• Maximum daily dose: Do not exceed 4000mg in 24 hours
• Best for: Patients with contraindications to NSAIDs (e.g., gastric ulcers, renal impairment)

Combination Therapy for Moderate to Severe Pain

For more severe toothache pain that doesn't respond adequately to single-agent therapy:

• Ibuprofen + Acetaminophen: This combination provides superior pain relief compared to either medication alone 3, 4
  • Ibuprofen 400mg + Acetaminophen 1000mg every 6 hours as needed
  • Fixed-dose combinations (where available) have shown excellent efficacy 5

Special Considerations

Duration of Treatment

• Use the lowest effective dose for the shortest duration consistent with pain control 1
• For temporary toothache pain, short-term use (2-3 days) is typically sufficient while seeking dental care

Contraindications for NSAIDs

• History of GI bleeding or ulceration
• Severe renal impairment
• History of hypersensitivity to NSAIDs
• Third trimester of pregnancy
• Severe heart failure

Common Pitfalls to Avoid

1. Inadequate dosing: Using too low a dose of ibuprofen (e.g., 200mg) may provide insufficient pain relief for dental pain
2. Extended use without dental evaluation: Medications treat symptoms but not the underlying dental problem
3. Using opioids as first-line: For most dental pain, non-opioid analgesics provide effective relief with fewer side effects 6
4. Applying aspirin directly to the gum/tooth: This folk remedy can cause chemical burns to oral tissues

When to Seek Dental Care

Pain medication should be considered a temporary measure while arranging for proper dental evaluation and treatment. Persistent toothache may indicate:

• Dental caries (cavity)
• Dental abscess
• Cracked tooth
• Periodontal disease

Definitive treatment of the underlying dental condition is essential for long-term resolution.