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HELP! Painkillers Aren't Working For My Toothache

Updated: Nov 14

If painkillers aren't working for your toothache, it means the condition is too severe to be self-treated because your condition needs professional treatment.


extra strength acetaminophen

Yes, you need to see a dentist because if even the OTC pain relievers aren't helping, the natural home remedies will be even less effective! Nonetheless, we do have a few tips for you to maximize your pain relief while you await your dentist appointment.


Table of Contents:


Tips for tooth pain relief

Painkillers alone may not work for a severe toothache because only professional treatment will bring you relief. However, there are ways to optimize the pain relief by combining a couple of well known tooth pain self-care practices.


advil dual action

How to relieve a severe toothache at home:

  1. Take advil dual action. Systemically alleviate the pain by taking this painkiller which combines ibuprofen WITH acetaminophen. When taken together, they work synergistically and provide greater pain relief. It's the best OTC painkiller.

  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 ice can numb the face and also help reduce swelling.

  4. Rinse with salt water. Keeping the mouth clean is imperative to minimize discomfort. Excessive food and plaque in your mouth typically worsens the pain.

  5. Eliminate irritants. If certain foods or actions that you do make the pain worse, you should strive to avoid doing them.

  6. Elevate your head while sleeping. Sleeping with an extra pillow underneath your head can offer relief. Sometimes when you lie flat, the blood will rush to your head and make the discomfort even worse.


Give our tips a try. They may help make the pain just bearable enough for you to make it to through to your dentist appointment. Sometimes they're not able to offer you an appointment immediately so you do need some help in the interim.


Most effective pain reliever you've never tried

You've been taking painkillers but you haven't been taking the best one. The best OTC painkiller is advil dual action which combines ibuprofen with acetaminophen.


advil dual action

Studies have shown that taking a ibuprofen with acetaminophen together produces greater pain relief than taking them individually. It is effective enough to be used to manage pain after wisdom teeth removal. The chart below describes the results.


acetaminophen with ibuprofen pain relief chart
Credit: Paul A. Moore, DMD, PhD, MPH; Hersh Elliot V., DMD, MS, PhD

Results of study:

  • Both ibuprofen and acetaminophen were effective in reducing pain.

  • However, the combination of both of them produced a greater analgesic effect than taking each of them individually/alone.


Mechanism of analgesia

The pain relief that you get from taking Advil Dual Action comes from two different mechanisms, one from ibuprofen and the other from acetaminophen. They work differently and block pain differently too, which explains why there is greater pain alleviation.


How ibuprofen blocks pain:

  • Inhibits the activity of cyclogenase enzyme (COX).

  • That reduces the formation of prostaglandins, which is akin to an on-off switch for pain control.



How acetaminophen blocks pain:

  • Inhibits the activity of COX pathway in a different manner than a NSAID.

  • The mechanism of action is still unclear.

  • Affects COX pathways in CNS (central nervous system) but not PSN (peripheral nervous system).



When it starts working

After taking Advil Dual Action, you should feel pain relief within 20-30 minutes.

  • The ibuprofen component takes 20-30 minutes for it to start working.

  • The acetaminophen component may take up to an hour for it to show effects.

Overall, you can expect to feel the full analgesic effect after about an hour or so.


How long it lasts


Why painkillers aren't working for my toothache

Mild tooth pain can be managed at home with OTC painkillers and various home remedies but severe toothaches are not at home manageable. The type of toothaches that we're talking about are the ones where you can't sleep.


The fact that taking pain medication isn't working for your tooth pain is affirmation that what you have is a severe toothache, not a mild one. There are 3 common dental conditions which can cause enough pain to render painkillers ineffective.


broken down teeth
broken down teeth

Dental conditions that may cause severe toothaches:

  • Irreversible pulpitis

  • Fractured tooth

  • Dental abscess with swelling


Irreversible pulpitis

Pulpitis that is irreversible is when the inflamed pulp can no longer recover back to a healthy state. The most notable symptom is severe tooth nerve pain that can even prevent you from getting a wink of sleep.


Since the tooth nerve can no longer revert back to a normal state, it requires permanent treatment. That involves a root canal which removes the unhealthy nerve from the tooth permanently.


Taking painkillers will do little to relieve the pain because the pulp is already beyond a state of repair. It requires permanent treatment and throwing temporary pain relief at it does nothing for it.


Cracked tooth

A cracked tooth can cause unbearable pain and this includes external and internal fractures.

  • External fractures: These are very obvious and visible even to the untrained eye. What you may see is a large part of the tooth may be broken off. The worst fractures are the ones where the tooth is broken down to the gum line.

  • Internal fractures: Unfortunately a crack inside of the tooth will be undetectable to the naked eye. These fractures originate from within the tooth. They will even give your dentist a tough time in figuring out that the tooth is cracked. This condition is referred to as the cracked tooth syndrome.


crown fractured off with no tooth left

As you can imagine, if your tooth is cracked in half it would be no surprise that it causes excruciating pain. It also will not be repairable at home.


Dental abscess with swelling

A dental abscess that results in significant facial swelling will be untreatable with OTC painkillers. For an infection of this degree, it will at the minimum require a dental abscess incision and drainage along with antibiotics.


throat swollen from dental abscess
throat swollen from dental abscess

Without those two treatments, you will never get pain relief nor get the swelling to reduce. Did you really think taking some pills will get rid of this condition? Think again.


See a dentist for permanent pain relief

Toothaches that cannot be relieved with painkillers will require professional treatment by a dentist. Without professional care, the toothache may last indefinitely. A commonality among all of these pain relieving dental procedures are all very physical in nature.


Pain relieving dental procedures:

  • Root canal. The unhealthy nerve will get physically removed from the tooth. Once its gone, the tooth will no longer be able to feel any pain.

  • Tooth extraction. The entire tooth gets physically removed 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 and then the swelling will get manually drained by your dentist.


extraction socket

The difference between these procedures and taking pain relievers is that they can treat the source of your pain.

  • It will permanently get rid of the tooth nerve or infection.

  • The medications will temporarily block pain signals but do nothing to eliminate the source of it.


Takeaway

To be clear, all of these pain alleviating tips are NOT a replacement for professional treatment by a dentist. What they will do is help reduce some of the discomfort temporarily but what they won't do is provide permanent relief.


In other words, the best thing you can do for your condition is to schedule a consultation with your dentist.

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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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