So while personally I would shun all of the following due to all the chemicals added to the formula and/or pills and go for salt water and/or other natural toothache and dental remedies instead whenever possible, obviously and by all means, I'd use and recommend using those chemical helpers in an emergency (where in my experience they can be a true blessing when topically applied!).[8]

One major caveat would concern children whom I'd avoid exposing to potentially/likely toxic chemicals to the extent possible. Taking the safety warnings accompanying Orajel Maximum Strength Anesthetic Pain Relief Gel as an example (see below), these chemicals are not to be trifled with and possibly come with serious so-called "side effects" (in reality, these are simply effects, and sometimes grave ones, at least with continued ingestion).

One of the most serious ones I have seen refers to ziconotide (aka Prialt or SNX-111) which according to a study authored by the Ruhr University in Bochum (Germany) has led to increased incidence of suicide. Also, aspirin, paracetamol (tylenol etc.), ibuprofen (motrin, advil etc.) and perhaps others apparently inhibit proper mineral absorption, with minerals of course being a pivotal nutrient for teeth as well as the rest of the body.[1]

As with natural pain relievers, chemical/allopathic analgesics or anti-toothache formulae are often just temporary remedies and will require your getting the tooth "fixed" by a dentist (which is also a temporary measure which can damage the ailing tooth even more)[2] or alternatively (and bravely) attempting to take its stabilisation and/or (in the best of cases) recovery in your own hands.

Here a list of chemical/allopathic toothache remedies including important warnings — generally be aware that (at least with long-term use) analgesics can cause gastro-intestinal bleeding (creating "holes" in the stomach and/or intestines) and liver / kidney damage since the body must detoxify / excrete them via these organs.

Conventional painkillers

Allopathical analgesics and over-the-counter (OTC) medications are pain relievers such as aspirin, acetaminophen [Tylenol], Ibuprofen[3] [Motrin, Advil, Nuprin] and hydrocodone [Vicodin], the most common perhaps being Aspirin and Paracetamol and its twin Acetaminophen[4].

As mentioned, the only way I found them effective (though I have only tried one or two of them at two occasions) was by directly lodging them against the painful tooth. In fact in the few cases I know of where salt and salt water or other natural remedies (such as garlic or urine rinses) didn't bring relief, application of an analgesic (half topically, the other half by ingestion just to be on the safe side [ingesting alone proved rather fruitless in my experience]) may prove indispensable and stop the pain within minutes, thus allowing restful sleep and subsequent "peace of tooth", the forming of a "healing" abscess etc.

Incidentally, a variation of the direct application technique consists in the following: put several aspirin or other analgesics in a bowl and crush them. Add warm water (and optionally some salt). Soak a cotton ball in the solution and place it on or next to the painful tooth. Reheat the solution and reapply as needed.

Acetaminophen / Paracetamol (Tylenol, Panadol etc.[4]) caveats

The US Food and Drug Administration (FDA) has issued a warning that drugs containing acetaminophen can trigger three serious skin reactions, two of which (Stevens-Johnson Syndrome [SJS] and Toxic Epidermal Necrolysis [TENS] potentially fatal. These skin reactions can occur even in those who have taken Acetaminophen-containing products with impunity beforehand.

Further significant health risks linked to acetaminophen drugs (at least with chronic use) include blood cancer (see further below), brain damage, blood pressure increase, hearing loss, reduced lung function, eosinophilic pneumonia, asthma, chronic obstructive pulmonary disease (COPD), acute renal failure, acute tubular necrosis, increased risk of renal cell carcinoma, and liver failure.

In fact, drugs containing acetaminophen (which is toxic to the liver) are the number one cause of liver failure in the USA.

Acetaminophen is found in 200+ OTC medications as well as a component of numerous prescription drugs such as Hydrocodone, Darvocet, Percocet and others.

According to one source, the risk of liver damage or failure is particularly high when taking (even the recommended doses of) acetaminophen after fasting for several days (such as following dental surgery). While normally, enzymes in the liver help remove the toxins produced by the acetaminophen, these enzymes cease to work effectively after five to seven days of fasting.

For what it is worth, notes that "[i]n a recent retrospective study of 306 patients admitted for acetaminophen overdose, 6.9% had severe liver injury but all recovered. None of the 306 patients died."

There does seem to be effective herbal help available against the hepatotoxicity (liver damage) induced by Paracetamol (at least it has been shown to work in mice).[9]

A large-scale study (64,839 participants) published in the Journal of Clinical Oncology (May 9, 2011) reported inter alia an 84 percent risk increase for certain blood malignancies (non-Hodgkin's lymphomas, myeloid neoplasms, plasma cell disorders) when acetaminophen was used at least four days a week for four years or longer.

(No such association was found for chronic lymphocytic leukemia/small lymphocytic lymphoma or for the increased use of aspirin, nonaspirin NSAIDs, or ibuprofen.[6]

Among the most serious findings also can be included those of the 2014 study published in Inflammation & Allergy-Drug Targets: "The Alzheimer pandemic: is paracetamol to blame?" which concluded that Alzheimer's disease is "primarily a man-made condition with paracetamol as its principal risk factor".[5]

Last but not least, a double-blind placebo-controlled study published in Social Cognitive and Affective Neuroscience in 2016 shows up a perhaps even more sinister side to this popular painkiller:

Acetaminophen not only suppresses our own awareness of pain but simultaneously our ability to understand and empathize with the suffering of others![7]

In a world where in countries such as the US nearly a quarter of the adult population takes acetaminophen in one form or another, the potential social side effects in terms of how people both in closer and broader relationships will interact with each other without that essential quality — the ability to properly perceive how our own or others' hurtful actions impact those around us — should not be underestimated. In the words of the study authors:

"Because empathy regulates prosocial and antisocial behavior, these drug-induced reductions in empathy raise concerns about the broader social side effects of acetaminophen".

Aspirin caveats

I have seen various warnings concerning the advice to lodge an aspirin directly against the aching gum or tooth (or biting down on it) to dull the pain for a while. While this should provide temporary toothache relief, it can also cause a so-called aspirin burn (inflammation of gum and cheek tissues).

A more serious warning concerns the connection of aspirin to developing Reye's Syndrome, a potentially fatal (but rare) disease afflicting children up to the ages of 19 and which can also cause severe abdominal bleeding in adults. Reye's syndrome most commonly occurs in children between four and nine years of age, damages liver and brain and leads to death in 40% of cases.

Last but not least, the Association of German nephrologists has called for a ban of aspirin since a large percentage of kidney damage cases is due to OTC aspirin (quoted from Die Heilkunst von Morgen).

Note: Regarding over-the-counter tooth pain relievers, a person commented that the "best toothache medication is one that contains a narcotic analgesic such as codeine. The best toothache antibiotic is usually Amoxicilin or Keflex, especially when a patient has a dental abcess toothache".

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1 See Minerals and trace elements: vital tooth and body builders.

2 See Drilling & filling teeth: an unwise choice? On risks, damages and dangers as well as numerous reasons for avoiding conventional invasive dental treatment.

3 Incidentally, ibuprofen has been found to be associated with more than three times the risk of stroke.

4 For a list of the various names used to market paracetamol all over the world, see e.g. Wikipedia.

5 See . Also refer to Alzheimer's & Dementia: On Suggested Causes & Cures.

6 See "Long-term use of acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs and risk of hematologic malignancies: results from the prospective Vitamins and Lifestyle (VITAL) study" at . The study can be read in its entirety at .

7 From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain.

8 See the sample toothache testimonial involving a conventional painkiller (Ibuprofen) featured near the top of the page.

9 See "Antioxidant properties of Taraxacum officinale leaf extract are involved in the protective effect against hepatoxicity induced by acetaminophen in mice." ( Summary under Taraxacum (dandelion) medicinal effects Scientific research studies show wide-ranging therapeutic potential Part 3.

More on conventional approaches in dentistry