Orajel is a legitimate topical local anesthetic so it does work in alleviating tooth pain and your dentist uses the generic version as a pre-numbing gel. It is not some voodoo home remedy where if you use it, your dentist looks at you as if you had two heads.
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Does orajel really work?
Orajel certainly works in alleviating toothaches because it is a legitimate topical anesthetic that all dental offices use. The only difference is that your dentist uses the generic version of orajel, which is pure 20% benzocaine. Benzocaine is the primary local anesthetic numbing agent in orajel.
The interesting thing is that Orajel is available over the counter but it actually contains MORE ingredients than generic benzocaine. The generic version of it is only available by prescription and requires a valid medical license. Ultimately you're actually using a more potent numbing gel at home than your dentist!
Orajel 4x ingredients:
Benzocaine 20% - oral pain reliever
Menthol 0.26% -pain reliever
Zinc chloride 0.15% - oral astringent
Benzalkonium chloride 0.13% - antiseptic
Generic benzocaine ingredients:
Benzocaine 20% - oral pain reliever
Since the numbing effect for orajel is derived from benzocaine, we can look at studies to determine how effective it is. Would it actually numb your tooth?
Studies on anesthetic efficacy
One study tested the effectiveness of benzocaine on teeth undergoing orthodontic treatment. As we all know, braces can cause the teeth to feel quite a bit of pain whenever the wires get tightened. The research found that use of 20% benzocaine significantly reduced the pain.
Another study tested the numbing efficacy of different concentrations of benzocaine. Some of them were 20% while others were 10%. The results were that all of them were effective in alleviating tooth pain for about 66% of the test subjects. However there were no differences between the differing concentration of benzocaine.
Overall it should be suffice to say that orajel does work in reducing tooth pain.
How does orajel work?
Orajel is a local anesthetic so it will only work in the area where it is applied. For instance if it is applied in the mouth it won't numb your foot.
Mechanism for how it works:
Benzocaine diffuses into the nerve cells and binds to sodium channels.
It prevents the opening of the channels, thus blocking the influx of sodium ions.
Since sodium ions are unable to diffuse into the cell, it cannot depolarize and therefore cannot generate an action potential.
The action potential is what signals to your body that you're feeling pain.
Normal process for action potential generation:
Sodium channels open.
Na diffuses into the nerve cell and depolarizes it.
Potassium channels open.
K diffuses out of the nerve cell and repolarizes it.
Since benzocaine prevents the sodium channels from opening, it effectively blocks the action potential generation at step one. If the nerve can't fire, it means that you won't feel any pain.
This is somewhat similar to how potassium nitrate, a nerve desensitizer in toothpaste works. Except that for the potassium it interferes with steps 3-4.
How long does it take for orajel to work?
After you apply the orajel to your tooth, it takes less than 60 seconds for it to start working. Therefore it is extremely fast for it begin numbing your tooth and providing you with pain relief.
The first study which tested 20% benzocaine, found that it took effect within 30 seconds of application. Then it continued to produce an numbing effect for the next 5-15 minutes.
The second study that tested benzocaine, found that it began producing a numbing effect within 60 seconds. The entire duration of the anesthetic lasted for about 5-10 minutes.
In conclusion, it should take about a minute for you to start feeling pain relief from using the orajel. Then the anesthetizing effect for orajel should last about 5-20 minutes.
All of the studies tested generic benzocaine but since orajel 4x has three additional ingredients, we extrapolated the data and added an extra 5 minutes to the working time. You can probably expect orajel to last for as long as 20 minutes at most before needing to apply more of this topical anesthetic.
Why is orajel not working?
If orajel is not working, it is most likely because you are trying to use it for a tooth condition that it was never intended to treat. Alternatively, you could also be using it wrong.
You would understand if you read the drug label on the product. It specifically says "for the temporary relief of pain due to minor irritation or injury of the mouth and gums". The emphasis is on MINOR.
Orajel was never meant to be used for major dental problems such as a raging toothache that keeps you up at night. The manufacturer even says that if the pain is so severe that it interferes with your daily activities you would need to see a dentist.
Therefore if it is not working for you it may simply be that your tooth condition is too severe for this product to work. It was never intended to be a replacement for serious dental conditions.
Contraindications for benzocaine
Despite the ease of use and accessibility of orajel as an OTC medication, there are certain individuals who should not use it.
Children under two. The label on orajel explicitly says that children below the age of 2 should NOT use it. There is a risk of methemoglobinemia, which is a medical emergency. However they do have a product for children that does not contain benzocaine, which is safe for them to use called orajel baby.
Orajel has been proven to work since it is similar to the same numbing gel that your dentist uses prior to giving you novocaine. In fact, it is more potent than the one they use since it contains more ingredients!
If it is not relieving your toothache as you are expecting, it may be that the condition is too severe for it to treat. After all, it was only meant to be for the temporary relief of minor dental problems.
For all severe toothaches, there is simply no other way than to see your dentist. If you're nearby you can come see one of our dentists in Long Island City for emergency dental treatment.