Ibuprofen (Brufen) for Toothache
Ibuprofen is the recommended first-line medication for toothache in both adults and children over 6 months of age, providing superior pain relief compared to paracetamol (acetaminophen) for dental pain. 1, 2
Dosing Recommendations
Adults and Children ≥12 Years
- Start with 400 mg every 6-8 hours as the standard effective dose for dental pain 3, 4
- Maximum daily dose: 2400 mg (2.4 g) per 24 hours 3
- Ibuprofen 400 mg provides at least 6 hours of pain relief in dental pain models 4
- The 400 mg dose is superior to 200 mg for moderate-to-severe dental pain 4
Children 6 Months to <12 Years
- Dose: 10 mg/kg per dose every 6-8 hours 5, 1
- Maximum daily dose: 40 mg/kg/day 5
- For children weighing >40 kg, use adult dosing 5
- Do not use ibuprofen in infants under 6 months of age 5, 6
Combination Therapy for Inadequate Relief
If ibuprofen alone provides insufficient pain control, add paracetamol (acetaminophen) rather than increasing the ibuprofen dose. 3, 1
Adults
- Paracetamol: 1000 mg every 6 hours (maximum 4 g/24 hours) 3
- Ibuprofen: 400 mg every 6-8 hours (maximum 2.4 g/24 hours) 3
- Stagger the medications so they are not taken simultaneously 3
Children
- Paracetamol: 10-15 mg/kg every 4-6 hours (maximum 60 mg/kg/day) 5
- Ibuprofen: 10 mg/kg every 6-8 hours (maximum 40 mg/kg/day) 5
- Alternate medications every 3-4 hours if breakthrough pain occurs 5
- The combination is more effective than either agent alone for moderate-to-severe pain 5, 1
Critical Safety Considerations
Absolute Contraindications
- Infants under 6 months of age 5, 6
- Active gastrointestinal bleeding or history of peptic ulcer disease 3
- Severe renal impairment (creatinine clearance <30 mL/min) 3
- Known hypersensitivity to ibuprofen or other NSAIDs 6
- Children with varicella (chickenpox) infection 6
- Children with persistent asthma or active wheezing 6
Use with Caution
- Dehydration is a major risk factor for renal toxicity - avoid ibuprofen in patients with diarrhea, vomiting, or inadequate fluid intake 6
- Cardiovascular disease: assess risk factors before prescribing 3
- Older adults: use lowest effective dose for shortest duration 3
- Consider gastroprotection (proton pump inhibitor) in high-risk patients requiring prolonged use 3
Important Clinical Pitfalls to Avoid
Do not use ibuprofen as monotherapy for dental infections (cellulitis, abscess). Antibiotics are mandatory for treating the underlying infection; ibuprofen only provides symptomatic pain relief. 7
Do not prescribe codeine or tramadol for dental pain in children <12 years. The FDA has issued a contraindication due to risk of serious respiratory depression and death. 8, 1
Do not exceed maximum daily doses. Ibuprofen >2.4 g/24 hours increases adverse events; paracetamol >4 g/24 hours risks hepatotoxicity. 3, 5
Counsel patients to check all other medications for hidden paracetamol content to prevent inadvertent overdose when using combination therapy. 5
When to Refer for Definitive Dental Treatment
Ibuprofen provides temporary symptomatic relief only. Patients must be referred for definitive dental treatment (pulp therapy, extraction, or other intervention) as soon as possible, as analgesics do not address the underlying pathology. 1, 2