Choosing a painkiller for toothache

A painkiller buys time, it does not treat the tooth

Toothache usually comes from decay reaching deeper into the tooth, an inflamed nerve, or infection collecting at the root tip. A painkiller changes none of that. It quietens the pain signal for a few hours so the wait until you are seen is easier to get through.

When the pain returns at full strength as the tablet wears off, the cause is still sitting where it was. Raising the amount on your own, or working through one packet after another, adds risk without settling anything. Pain that runs past a few days, or wakes you every night, belongs with the tooth rather than the medicine cabinet.

What separates the two main groups

Painkillers sold over the counter fall roughly into two groups. One eases pain and damps down inflammation and swelling at the same time; the other acts mainly on pain and fever and tends to be gentler on the stomach. Inflammation is part of the picture in most toothache, which is why the first group suits many people better. That is a general statement, though: which one fits you is a question for your pharmacist or dentist.

Combination remedies for colds and flu often contain the same active ingredients. Taking the same substance from two different packets without realising it quietly raises the risk of side effects. Reading the ingredients line on the box, or asking at the pharmacy, prevents that overlap.

Situations that need advice first

In some circumstances the choice of painkiller depends on the person, and the wrong one causes more trouble than the toothache did. If any of the points below applies to you, it is safer to ask at the pharmacy or at the dental practice before the box is opened.

• Heartburn, reflux or a past stomach ulcer
• Kidney or liver disease
• Blood-thinning medicines
• Pregnancy and breastfeeding
• Asthma, or medicines for blood pressure and the heart
• Children, where a choice that suits an adult may not suit them

Pain that does not respond to tablets is not automatically bad news: root canal treatment or draining an abscess settles it far faster than any medicine does.

Never put medicine on the tooth or gum

Crushing a tablet and holding it against a sore tooth is a common household remedy and a harmful one. Where the tablet touches the gum it causes a chemical burn: the area turns white, then peels, leaving a painful ulcer underneath. That ulcer is added to the toothache, not a substitute for it. Painkillers work once they reach the bloodstream, not by contact.

Heat can make the swelling worse

A hot water bottle or a warmed cloth against the cheek feels soothing at first, but it increases blood flow to the area and the swelling can grow along with it. Where infection is involved, the pain often climbs within a few hours. Something cool held against the outside of the cheek is safer, wrapped in a thin cloth and used in short spells.

Other things help while you wait: sleeping with your head raised a little, chewing on the other side, and staying away from very hot and very cold drinks. Rinsing with warm salty water settles the mouth, though it leaves the cause of the pain untouched.

Signs that cannot wait

Most toothache can wait a few days for an appointment. Some signs cannot, because they show the inflammation spreading beyond the tooth. If any of these appears, seek dental or medical care the same day, without delay; a painkiller can mask this picture for a few hours and hide how far it has gone.

• Swelling of the face, under the eye or under the jaw
• Difficulty opening your mouth or swallowing
• Difficulty breathing, a change in your voice or swelling under the tongue: this one does not wait for a dental appointment, go to A&E immediately
• Fever, shivering or feeling generally unwell alongside swelling
• Pain spreading quickly and not easing at all with medicine

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