Toothache & Swelling

Example – a tooth or an area of your mouth that you may have not noticed before suddenly flares up with swelling and/or a toothache.

The first choice of treatment, of course, is to see a dentist. If this is not possible (e.g. this occurs at night or on a weekend) then what follows might be of help to tide you over for a short period of time.

If you have been told previously that you have a cavity in the area that is bothering you but have not had it attended to for whatever reason, you need to see a dentist. Unfortunately, when a tooth with a long standing cavity is painful, it is often not possible to fix the problem by simply filling the tooth.

There was a report in JADA (Journal of the American Dental Association) in Sept 2010 about the number of patients who were hospitalized for dental abscesses in the US in 2007. That number was 7886. The average stay in the hospital was for 3 days, and at an average cost of $13,590. We are not talking about people who go to the emergency room with a toothache, receive antibiotics, and then go home. We are talking about people whose dental infection is so serious they require treatment as an in-patient.

Pain relievers

DO NOT put any type of pill on the gum next to the tooth. The old myth of putting an aspirin on the gum not only will not work, it can damage the gum and add to your overall discomfort.

For dental pain, an NSAID like ibuprofen are the OTC drugs of choice (e.g. Ibuprofen, Advil, Aleve, et). It is best to take one you have taken previously without having had any problems. Take as directed on the bottle, but take it regularly and not just when the tooth is bothering you – i.e. avoid the “on again/off again” type of approach until a dentist can be seen. Do not take on an empty stomach.


In general, Tylenol (acetaminophen) is a poor drug choice for dental pain. Some people have to use Tylenol because of problems taking ibuprofen or aspirin. Tylenol can be a dangerous drug, in my opinion. For example, it is the number one cause of acute liver failure in the US.

There was a report (May 2010) of a young college girl with a toothache who “couldn’t take the time from her studies to see a dentist”. She was taking 9 tablets of “Extra Strength Tylenol” (500 mg) a day for several weeks. The maximum recommended dose is eight 500 mg tablets/day (this has now been changed) – so she was just over the limit. After doing this for several weeks, she developed flu-like symptoms and died two days later of liver failure!

Tylenol (acetaminophen) is an added ingredient in a lot of medicines that you might not be aware of, so overdosing can occur inadvertently. For example, many cold medicines contain up to 500 mg of Tylenol per dose. Also “combination medicines used to treat allergy and insomnia can have acetaminophen. Commonly prescribed pain medications such as Vicodin contain acetaminophen.

Tylenol should not be combined with alcohol or used by patients who have kidney or liver disease, are fasting, or who are taking Coumadin.


Aspirin is another good medication for dental pain. It has to be avoided in children and teenagers (especially if they have a fever) due to the possibility of causing Reye’s syndrome. So, it should only be use by a person who has taken it previously without problems. If you can take aspirin but it causes stomach (GI) problems, a buffered aspirin (such as Bufferin) can be of help. Aspirin is also a major ingredient in Alka-Seltzer.

Patients taking SSRIs (used to treat depression, obsessive compulsive disorder and anxiety) could experience increased intestinal bleeding when taking NSAIDs e.g. ibuprofen (e.g. Motrin, Advil, Nuprin), Naproxen (e.g. Anaprox, Naprosyn, Aleve), Celebrex, Voltaren, Cataflam, Mobic, or aspirin. Common SSRI’s are Celexa, Prozac, Paxil, Zoloft, and Lexapro. As said previously, if you have taken any NSAID in the past and have had no problems, then you should be able to take them short term for dental pain – to tide you over a weekend, etc. But for patients taking SSRIs, the longer you take NSAIDs the higher are the chances for intestinal bleeding to occur.


Swelling is a sign of an infection. Again, the first choice is to see a dentist. If this is not possible to do right away (e.g. you are away, or it occurs at night or on a weekend) the first line of treatment is often an antibiotic (to get the infection under control).

For tooth problems, penicillin (or Amoxicillin) is the antibiotic of choice (provided you are not allergic to it – e.g. you have taken it before without any problems). If you happen to have some penicillin at home, you could start taking it under these circumstances. Do not start, however, if you do not have enough to last until you can contact a dentist (e.g. Monday morning). Starting and stopping, then starting up again is not a good idea and can lead to bacterial resistant organisms developing (e.g. MRSA). For those allergic to penicillin, the next antibiotic commonly used in dentistry is Clindamycin.

If you are unable to see a dentist, another option is to go to the hospital emergency room because with a toothache or swelling, the first line of treatment usually would be an antibiotic and pain relievers. These would be available at the emergency room. This can tide you over a weekend until Monday morning

Precautions for women taking antibiotics:

Birth Control:

The effectiveness of your birth control may be lessened whenever you are taking an antibiotic. It is advisable to use additional birth control for the next two weeks.

Yeast Infections:

Patients who are susceptible to getting yeast infections while on antibiotics should be eating yogurt with live cultures as a preventative measure.


If you think you might be pregnant, consultation with your obstetrician prior to the taking of any antibiotic is advisable. In addition, Tetracycline should not be taken during pregnancy as it can cause discoloration of developing teeth.


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