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Ibuprofen Not Working For Toothache: Causes & Alternatives

Updated: Dec 19, 2023

If taking ibuprofen is not working for your toothache, it means that your tooth condition is too severe to be treated at home. I mean, you do realize that this painkiller is only meant for minor tooth pain and mild bodily aches right?


ibuprofen 200mg

Ultimately, what this means for you is that you need to see a dentist to permanently get rid of the toothache. Nonetheless, we'll still provide you with some alternatives on what to do in the meantime while you wait for your dental appointment.


Yes, there are better ways to manage tooth pain than simply taking ibuprofen alone but firstly you should understand why painkillers don't work sometimes.


Table of contents:


When ibuprofen doesn't work

When taking ibuprofen doesn't help your toothache, it simply means that your condition is too severe for OTC painkillers. This pain medication was never meant to treat severe tooth pain and evidence of that can be found on the label.


advil dual action - label uses directions warnings

As per the "uses" section of the drug label, it specifically says that the painkiller can "temporarily relieve minor aches and pains due to toothache". The emphasis is on minor toothaches. Nowhere does it say that it can permanently get rid of severe tooth pain.


Severe tooth pain conditions that render ibuprofen ineffective:

  • Irreversible pulpitis. This type of pulpitis is due to a dying tooth nerve which results in an unbearable toothache that can prevent you from even sleeping. If you have this, there is no chance in the world that ibuprofen would even have an effect.

  • Fractured tooth. A tooth that is cracked in half can cause excruciating pain. Taking pain medication may temporarily alleviate a bit of the pain but it doesn't repair the tooth. As long as that tooth is split in half, the pain will be persistent.

  • Dental abscess with swelling. A severe tooth infection can result in an abscess with facial swelling. The swelling can be extremely disfiguring and painful. Typically taking pain relievers and antibiotics will do nothing to alleviate the pain. The only way to get pain relief is by physically draining the abscess.


Unfortunately if your pain is due to one of the above conditions, taking ibuprofen will have little effect.


When ibuprofen works for a toothache

Ibuprofen can help alleviate a toothache but only if it is a minor one. Its effectiveness decreases as the severity increases. Therefore you can expect less relief for a moderate toothache and almost no help at all for a severe aching tooth.


Minor conditions which can be alleviated:

  • Gum injury. Abrasion by hard foods, pizza burns on the palate, etc.

  • Chipped tooth. Sore or tender tooth from biting into hard foods.

  • Canker sore. Small ulcer on the lip or cheeks in the mouth.

  • Discomfort after a cavity filling. Tooth and gums may feel tender after a filling.

  • Denture pain. Sore spots may be present underneath the denture.

  • Orthodontic pain. Moving teeth can be painful after a braces adjustment or when switching to a new set of aligner trays.


What to do if ibuprofen is not helping tooth pain

While you wait for your dentist appointment, here are some tips that you can implement to help alleviate some of the tooth pain. You may not have been doing some of these or you could've been potentially using them the wrong way.


Either way, these tips will be more effective than taking 2 pills of ibuprofen as per the label directions.


How to manage an unbearable toothache:

  1. Take advil dual action. The dual action version of advil is more than just ibuprofen because it combines it WITH acetaminophen. In other words you're taking two different painkillers in one pill. They work together synergistically and provide greater pain relief than when taken alone individually. It's the best OTC option for pain medicine.

  2. Use a topical analgesic. Topically alleviate the pain by using a numbing gel like Orajel or Anbesol. This treats the tooth from the surface which is different from a systemic medication that treats it via the bloodstream.

  3. Apply a cold compress. The cold can numb the face and also help reduce facial swelling.

  4. Rinse with salt water. Rinsing with salt water can help keep the mouth clean, reduce place, and eliminate irritants. It is the gentlest rinse that won't aggravate irritated nerves.

  5. Eliminate irritants. If certain foods make the pain worse, you should to avoid eating them. If certain actions like sucking in cold air bothers it, you should cease that as well.

  6. Elevate your head while sleeping. Sleeping with an extra pillow underneath your head can provide pain relief. When you lie flat on your bed, blood will rush to your head and cause pressure build up in the head, neck, and mouth which makes the discomfort worse.


advil dual action
advil dual action

The above are what we would recommend that you do. There are other home remedies that you can use such as essential oils (clove oil, oregano oil, tea tree oil) and etc. However, they're not as effective as the ones we've listed above.


Ibuprofen with acetaminophen is more effective

The Journal of the American Dental Association (JADA), has conducted multiple studies which showed that combining ibuprofen with acetaminophen was one of the most effective pain relievers for toothaches.


In a 2013 study, they found that the combination of both drugs produced a greater analgesic effect than taking either of them alone.

  • 400 mg of ibuprofen was more potent than 1000 mg of acetaminophen.

  • 200 mg ibuprofen + 500 mg acetaminophen was more effective than either alone.

  • 400 mg ibuprofen + 1000 mg acetaminophen was the most effective.


acetaminophen with ibuprofen pain relief chart

With these new findings, the ADA has revised their pain management protocol.


ADA pain management protocol

The American Dental Association does not specifically mention advil dual action but uses generic acetaminophen and ibuprofen. Below is the acute pain management strategy by the ADA for each severity of tooth pain.


Mild pain:

  • Ibuprofen 200-400 mg as needed for pain every 4-6 hours.


Mild to moderate pain:

  • First 24 hours - Ibuprofen 400 to 600 mg every 6 hours.

  • After 24 hours - Ibuprofen 400 mg as needed for pain every 4 to 6 hours.


Moderate to severe pain:

  • First 24 hours - Ibuprofen 400-600 mg plus acetaminophen 500 mg every 6 hours.

  • After 24 hours - Ibuprofen 400 mg plus acetaminophen 500 mg as needed for every 6 hours.


Severe pain:

  • First 24-48 hours - Ibuprofen 400-600 mg plus acetaminophen 650 mg with hydrocodone 10 mg every 6 hours.

  • After 48 hours - Ibuprofen 400-600 mg plus acetaminophen 500 mg as needed for pain every 6 hours.


The ADA reiterated that as per the 2013 study, that 400 mg of ibuprofen with 1000 mg of acetaminophen was more effective at controlling pain than opioids. That is based on the results of pain relief for 58,000 wisdom teeth extractions.


When to see a dentist

As a general rule of thumb, if the painkiller isn't working for your toothache you need to see a dentist right away. That includes all of the available OTC pain medicines such as ibuprofen, acetaminophen, aspirin, and naproxen.


The condition causing the severe tooth pain is most likely too severe for just medication to handle. Aside from that, pain relievers only relieve the pain temporarily anyway. If you wanted to permanently treat the source of the aching tooth, you would need to see a dentist regardless.


Potential treatments to eliminate severe odontogenic pain:

  • Root canal. The unhealthy nerve will get mechanically removed from the tooth's pulp chamber. Once its gone, the tooth will be nerveless and no longer feel pain.

  • Tooth extraction. The entire tooth gets extracted from the jaw bone. This will eliminate not only the tooth but the nerve inside of it as well.

  • Incision and drainage. An incision will be made into the swollen abscess so that the infection can be drained. Afterwards the area will get flushed out with an antibiotic solution.


The above three dental treatments are the only ways to permanently get rid of the tooth nerve for lasting pain relief. Painkillers will alleviate the symptoms temporarily but do nothing to treat the source, which only your dentist can do.


Takeaway

If you're taking ibuprofen and it isn't working for your toothache, it means that you need to see an emergency dentist because its too severe. Home remedies and OTC medications will not help for severe tooth pain.


We recommend seeing a dentist as soon as possible but nevertheless, there are still tips that you can implement to help reduce the discomfort while you wait for your appointment. Our dental office in long island city can help get you out of pain!

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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