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The Absolute Best Pain Reliever For Toothache: Yes, It's OTC

The best pain reliever for a toothache is advil dual action, which is formulated with ibuprofen and acetaminophen together into one pill. Yes, it is available over the counter and it is even more effective than taking opioids.


advil dual action

We'll provide you with in depth research to explain why opioids don't take the crown for being the best painkiller. We'll also talk about the runner ups for pain medications in alleviating tooth pain in case you can't find the best one.


Table of Contents:


Best painkiller for toothache

Without a doubt, the best painkiller for tooth pain is advil dual action because it contains two toothache medicines, acetaminophen and ibuprofen.


Why it's the best:

  • Studies have shown that taking both pain medications together will create a synergistic effect in relieving dental pain.

  • It is also recommended by the ADA as a part of their acute pain management strategy.


What it'll work for:

  • Toothache or tooth pain

  • Tooth nerve pain


Scientific evidence

Over the years, the Journal of the American Dental Association (JADA), has come out with multiple studies which showed combining ibuprofen with acetaminophen was one of the most effective pain relievers for oral pain.


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
Credit: Paul A. Moore, DMD, PhD, MPH; Hersh Elliot V., DMD, MS, PhD

A 2018 study found the combination of these two OTC medications was even more effective than taking opioids for dental pain.


Pain Medication

% with at least 50% maximum pain relief

400mg ibuprofen + 1000mg acetaminophen

72%

1000mg acetaminophen + 10mg oxycodone

68%

400mg ibuprofen + 10mg oxycodone

60%

Isn't it absolutely amazing than an over the counter medication can outperform a prescription strength opioid painkiller?


Mechanism of analgesia

The reason why the combo works so well is because ibuprofen and acetaminophen block pain via different mechanisms. This difference creates a synergistic effect that provides greater pain relief than when taken alone.


How ibuprofen blocks pain:

  • Inhibits the activity of cyclogenase enzyme (COX).

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

How acetaminophen blocks pain:

  • Inhibits the activity of COX pathway but 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).


Since they work via different mechanisms and pathways, taking both is akin to covering areas where the other is lacking. That makes them complimentary, thus creating a synergistic effect.


ADA pain management protocol

The American Dental Association does not specifically mention advil dual action but uses its generic version instead. Below is the acute pain management strategy by the ADA. It explains what pain medication and how much of it that you should take for each level of pain.


Mild pain regime:

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


Mild to moderate pain regime:

  • 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 regime:

  • 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 regime:

  • 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 pain relief for 58,000 wisdom teeth extraction cases.


Second best pain relievers for tooth pain

The next best painkillers after advil dual action would be the individual pain relievers.

  • Ibuprofen (Advil, Motrin)

  • Acetaminophen (Tylenol)

  • Naproxen (Alleve)

  • Aspirin


Typically, the NSAIDs (non-steroidal anti-inflammatories) are preferred over a non-NSAID like acetaminophen. The anti-inflammation is very helpful in managing tooth pain.


Ibuprofen is the drug of choice for dental pain management for the vast majority of dentists. It is safe and effective. We'll compare ibuprofen to the other types of pain medications.


Ibuprofen vs Acetaminophen

The main difference between the two is that one is an anti-inflammatory while the other is not.


acetaminophen and ibuprofen

Ibuprofen effects:

  • Anti-inflammatory. Decreases swelling, redness, and inflammation.

  • Analgesic. Can block pain signals, thus numb your body to pain.

  • Anti-pyretic. Reduces fevers.


Acetaminophen effects:

  • Analgesic

  • Anti-pyretic

  • It is NOT anti-inflammatory, which is why it's not a NSAID (non-steroidal anti-inflammatory drug).


Ibuprofen vs Naproxen

Studies have shown that both ibuprofen and naproxen were effective in reducing toothaches but they do have some differences.

  • Naproxen has a longer duration of effect. You can take one pill every 12 hours vs every 6 hours for ibuprofen.

  • Ibuprofen is safer on the stomach. GI bleeding and other disturbances were less.


Ibuprofen vs Aspirin

Dentists prescribe ibuprofen much more frequently than aspirin despite both being a NSAID. The main reason for doing so is because aspirin also has a blood thinning property. Even a baby aspirin (81 mg) is enough to increase post-operative bleeding after surgical dental procedures.


Surgical dental procedures:

  • Tooth extraction

  • Wisdom teeth removal

  • Gum surgery


Taking a full dose of aspirin (325 mg) or extra strength (500 mg) may significantly increase post-surgical bleeding. Due to that risk, most dentists prefer to not prescribe aspirin unless absolutely needed.


What about antibiotics?

While a severe tooth infection accompanied by facial swelling is often treated with antibiotics along with painkillers, the antibiotic does not relieve pain. That means taking the often prescribed amoxicillin does not reduce your toothache.


Reasons to take antibiotics:

  • Eliminates infection which may indirectly lead to lessened pain.

  • Prevents the abscess from getting worse or coming back.


Common dental antibiotics:

  • Amoxicillin

  • Clindamycin

  • Erythomycin

  • Cephalexin

  • Doxycyline

  • Augmentin


Takeaway

The best pain reliever that you could use for tooth pain is advil dual action. The best part of it all is that it is an OTC medication so you don't need a prescription for it. If that wasn't good enough for you, you should be glad to know that it is more effective than opioids.


Therefore, if you're having a toothache and need emergency dental treatment, you can try taking some advil dual action while you wait to be seen by 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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