Severe toothache is one of the worst pains in dentistry. Throbbing, constant, often worse when lying down, sometimes radiating to the jaw and ear. Most patients reach for whatever painkiller is in the bathroom cabinet, take whatever the packet says, and find it does not touch the pain. There is a better approach.
Combine ibuprofen and paracetamol
The single most effective over-the-counter approach for severe toothache is to take ibuprofen and paracetamol together. They work on different pain pathways — ibuprofen reduces inflammation, paracetamol blocks pain signals centrally — and the combined effect is materially greater than either alone. Adult dosing:
- Ibuprofen 400mg every 6 hours (maximum 1200mg per day OTC; a doctor can prescribe higher)
- Paracetamol 1000mg every 4–6 hours (maximum 4000mg per day)
- You can take both at the same time, or stagger them — both work
This combination is not magic — it will not work as well as a dentist actually treating the cause — but it makes the wait considerably more bearable. Check the packets for any contraindications and do not exceed the stated doses.
What to avoid
- Aspirin against the gum — the old myth. Aspirin is acidic and burns soft tissue. It does nothing for the tooth and produces a chemical ulcer.
- Whisky against the tooth — alcohol mucosal application briefly numbs but the underlying pain returns intensified.
- Hot food and drink — heat dilates the inflamed pulp tissue and increases pain dramatically.
- Very cold food and drink — for the same reason, cold can spike pain in an inflamed tooth.
- Lying flat — gravity reduces blood flow to the head and reduces throbbing pain. Sleep with two or three pillows propping you up.
Things that help mildly
- Warm (not hot) salt-water rinses — a teaspoon of salt in a cup of warm water, rinsed several times. Particularly helpful where there is gum swelling.
- Clove oil dabbed sparingly on the tooth using a cotton bud — eugenol in clove oil has mild local anaesthetic effect. Do not swallow.
- Cold compress on the cheek (not directly on the tooth) — for visible facial swelling.
When to escalate beyond the matching service
Call NHS 111 (free, 24/7) or 999 if you have any of:
- Facial swelling spreading towards your eye, throat, or neck
- Difficulty swallowing or breathing
- High fever (over 38.5°C) with shaking chills
- Generally feeling very unwell — disoriented, severely fatigued
Spreading orofacial infection is a medical emergency requiring hospital admission, not a paid private dental visit. The matching service is for dental-only emergencies; call 111 or 999 for spreading infection signs.
Why the dentist visit matters even after symptoms settle
Severe toothache that "settles by itself" is rarely good news. Most often it means the nerve has died and stopped sending pain signals — the underlying decay or infection is still progressing, just silently. Three weeks later it returns as an abscess or facial swelling. The matching service introduces you to a dentist who will diagnose the cause whether the pain has settled or not.
This is a dental matching service, not a medical service
For genuine medical emergencies — uncontrolled bleeding, facial swelling spreading to your eye, throat or neck, difficulty breathing or swallowing, or feeling severely unwell — these are hospital problems and need IV antibiotics, not a dental appointment.