Managing toothache and teething pain

Toothache can range from mild, caused by a temporary gum irritation; to severe, where the problem might be a cavity or infection.^1a

It’s important to consult a dentist about toothache, as any pain can potentially mean a dental problem that needs attention, and even a small injury to the teeth or gums may lead to further damage. Your dentist can quickly reduce the pain and identify the cause.^2a

While waiting for a dental appointment, the following home care measures will help provide short-term pain relief.^3a

Non-prescription pain medications such as paracetamol or ibuprofen can ease toothache in the short term.^1b

For example, Panado (which contains paracetamol) has a wide range of products formulated for pain relief in adults and children. The table below shows suitable products according to the patient’s age.^4-11

Over-the-counter pain-relieving gels and liquids are applied directly to the sore tooth and gum. These products contain benzocaine, which helps numb the area for a short while.^3b

Note that benzocaine has been linked to a rare, serious condition that affects the blood’s ability to transport oxygen. Follow directions when using benzocaine products and don’t exceed recommended amounts. Benzocaine is not considered safe for children under 2 years.^3c

Mouth rinses can help ease toothache and disinfect the mouth:^1c

• Salt water rinse. Dissolve a half-teaspoon of salt in about a cup of warm water, rinse for 30 seconds, then spit out.
• Hydrogen peroxide rinse. Rinse with equal parts hydrogen peroxide and water. Never use hydrogen peroxide undiluted, nor swallow it.

Small children shouldn’t try either of these rinses as they may swallow them.^12a,13

Take care when eating

Choose soft foods, such as yoghurt or scrambled egg, and avoid chewing on the sore tooth. Skip foods that are very hot, cold or sweet.^12b

Cold compress (ice pack)

If toothache is accompanied by facial swelling, try placing an ice pack or a bag of frozen vegetables wrapped in a cloth on your cheek for about 20 minutes, several times a day.^1d

This may ease the pain, especially with a chipped or loose tooth. Note that swelling could mean you have an abscess, a collection of pus in the tooth root.^3d

Toothache often feels worse at night simply because you have fewer distractions. In addition to other home treatment measures, try elevating your head with pillows. This may help reduce inflammation and pain, allowing for better sleep.^3e

You might be able to ease your pain in the short term with home care, but the underlying problem will likely remain. Many causes of toothache need a dentist’s care.^3e

See your dentist if you have toothache and:^12c

• It persists longer than 2 days
• It doesn’t improve with over-the-counter pain medications.
• You also have a fever, pain on biting, red gums or a bad taste in your mouth, and a swollen cheek or jaw.

Get emergency medical attention if you have toothache and:^12d

• There is swelling around your eye or neck
• A swollen mouth or neck makes it hard to breathe, swallow or speak.

Your dentist will examine your teeth and may take an X-ray to diagnose the source of pain and to guide treatment. Antibiotics may be prescribed if there are signs of infection.^3f

Some babies are born with their first teeth; others start teething before 4 months, and some after 12 months. But teething usually starts in the first year at around 6 months.^14a Most children will have all their milk teeth between 2 and 3 years of age.^14b

Teething symptoms

Baby teeth sometimes emerge with no discomfort. At other times, you may notice that your child:^14c

• Has a sore, red gum where the tooth is emerging
• Has a mild temperature – under 38°C (degrees Celsius)
• Has one flushed cheek
• Has a facial rash
• Keeps rubbing one ear
• Dribbles more than usual
• Chews on things a lot, such as their fingers or toys.
• Is more fretful than usual
• Isn’t sleeping well.

Teething can be distressing, but there are ways to help your child through it. You may have to try several remedies until you find what works best.^15a

A sugar-free non-prescription pain medication, such as paracetamol, can help to ease teething pain. This is suitable for children aged 3 months and older.^15b Examples of products are Panado^® Paediatric Syrup (Strawberry) and Panado^® Infant Drops.^9,10

Always follow the instructions that come with the medicine, and if you’re unsure, speak to your doctor or pharmacist.^15b

Teething rings and other safe “chewing” items

Teething rings provide a safe surface to chew on. This helps ease discomfort and distract your child from any pain. Some teething rings can be cooled first in the fridge, which helps soothe the gums. Don’t freeze teething rings though, as this could be too hard and damage your baby’s gums.^15c

If your baby is 6 months or older, give them healthy snack items to chew on, such as raw fruit and vegetables. Soft fruit like melon can be soothing to gums. Avoid high-sugar foods, as this can cause tooth decay.^15d

Comforting a teething baby

Comfort or play with your baby to distract them from teething pain. Gently rubbing the gums with a clean finger may also help.^15e

Teething gels

There is insufficient evidence that teething gels are effective. If you wish to try a gel, use one that’s specially formulated for young children. Note that general oral pain relief gels are unsuitable for children.^15f

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