What is the best way to relieve tooth pain?

Management of Tooth Pain

For acute tooth pain, over-the-counter NSAIDs (ibuprofen 400-800mg) or acetaminophen provide effective first-line analgesia while the patient seeks immediate dental evaluation to address the underlying dental pathology. 1, 2, 3

Immediate Actions and Red Flags

Seek emergency dental care immediately if any of the following are present:

• Facial swelling (localized or progressive) requires urgent dental referral, as this indicates spreading infection that may need aggressive antibiotic therapy and possible hospitalization 4, 5
• Fever, malaise, or cellulitis suggests systemic spread of dental infection requiring immediate intervention 5
• Severe spontaneous pain that is site-specific typically indicates pulpal involvement (pulpitis) requiring root canal therapy or extraction 4, 5
• Tenderness on firm percussion (test with tongue depressor) indicates infection has spread into subdental tissue and requires definitive dental treatment 4

First-Line Pain Management

NSAIDs are superior to acetaminophen for dental pain because they provide both analgesic and anti-inflammatory action, directly addressing the inflammatory component that causes most dental pain 3:

• Ibuprofen 400-800mg is the most commonly used and effective NSAID for dental pain 1, 3
• Peak pain relief occurs 1-2 hours after administration 1
• Acetaminophen provides effective analgesia but lacks anti-inflammatory action, making it less ideal for dental pain 2, 3
• Avoid opioids (including codeine combinations) unless pain is severe and unresponsive to NSAIDs, as they have significant side effects without addressing inflammation 3

Underlying Causes Requiring Dental Treatment

Medication only provides temporary relief—definitive dental treatment is essential to resolve the pain source 3, 4:

• Dental caries (cavities) causing pulpitis requires root canal therapy or extraction 5
• Post-extraction pain (24-48 hours after extraction) with absent blood clot and severe socket tenderness indicates dry socket (alveolar osteitis) requiring dental management 4
• Pericoronitis (infected gum tissue around partially erupted wisdom tooth) presents with erythematous, tender gingiva and requires irrigation or surgical extraction 5
• Cracked tooth syndrome causes bizarre, difficult-to-localize pain and requires early diagnosis for successful restorative management 6
• Dental abscess requires drainage and either root canal therapy or extraction 5

When to Consider Non-Dental Causes

If dental examination reveals no obvious pathology, consider these alternate diagnoses 7:

• Referred pain from masticatory muscles (especially digastric muscle trigger points) may respond to muscle stretching, gentle massage, and NSAIDs 7
• Neuropathic pain (persistent pain after pulpectomy or extraction) may require tricyclic antidepressants like amitriptyline 7
• Giant cell arteritis in patients over 50 with jaw claudication requires immediate ESR/CRP testing and high-dose corticosteroids 8, 9

Critical Pitfalls to Avoid

• Never rely solely on pain medication without addressing the underlying dental pathology—this leads to treatment failure and potential complications 3, 4
• Do not dismiss progressive facial swelling—this requires same-day dental or emergency department evaluation 4, 5
• Avoid prescribing opioids as first-line therapy—NSAIDs are more effective for inflammatory dental pain 3
• Do not assume all tooth pain is dental—consider referred pain, neuropathic pain, and systemic causes when examination is unrevealing 7

Referral Pathway

All patients with tooth pain should see a dentist within 24-48 hours for definitive diagnosis and treatment 4, 5:

• Same-day referral for facial swelling, fever, or severe pain 4, 5
• Routine dental referral (within days) for persistent pain without emergency features 3
• Consider pain management specialist only if pain persists despite appropriate dental treatment 7