To choose the right medicine for a toothache, it is important to first be clear about the cause of the toothache and the condition of the disease. Clinically, the diseases most likely to cause toothache are pulpitis, periapical periodontitis, pericoronitis, etc. Pulpitis Some patients with pulpitis have obvious pain when brushing their teeth with cold water, but feel less pain when using warm water instead; some patients also feel pain when eating and drinking hot soup, and have to wait for the soup to cool before they can drink it; if it continues to develop, some patients will have pain for no reason, especially at night after lying down to sleep, the pain will be more severe, and even affect sleep. This is what doctors often call “hot and cold stimulation pain, spontaneous pain at night”. The inflammation site of pulpitis is in the central pulp cavity of the tooth, and the drug has to pass through the tiny apical hole to reach it, so it can be said that no drug can completely treat pulpitis, so there is some truth to the statement that pulpitis is “incurable”. Many patients with pulpitis who are suffering from toothache turn to the doctor in a hurry, and those unprofessional doctors prescribe some antibiotics for the patient, which do not work at all. For the pain caused by pulpitis, painkillers have a certain role, but when the pain is severe, the role of painkillers will not be obvious. Topical painkillers such as “toothache pills” may be effective when the pain is mild, but they are not a good solution. When pulpitis occurs, it is best to see a dentist to treat the tooth, and oral painkillers can be used if there is already pain before seeing the dentist. Periapical Inflammation Generally, pulpitis progresses further and bacteria invade the tissue around the root tip of the tooth resulting in periapical inflammation. In the early stages of inflammation the patient may feel a floating sensation in the tooth, tend to bite into the diseased tooth, and feel pain when the tooth bites down. In the early stages, the use of antibiotics and anti-inflammatory pain medications is of little significance in controlling the inflammation, although it is of some help, because the inflammation is relatively small in extent. Professional dentists still emphasize local drainage and local medication, and doctors usually evacuate the tissue from the tooth to the periapical area and place local anti-inflammatory and pain medications, such as camphorol. Patients with periapical inflammation who are not treated promptly and the inflammation expands may experience redness, swelling, heat and pain in the cheek, pus, and even fever and generalized pain. At this point, it is necessary to use antibiotics and anti-inflammatory painkillers for the whole body (broad-spectrum antibiotics and methotrexate, i.e., metronidazole, are commonly used); painful patients can add painkillers such as depot tablets, and those with severe pain can also be injected with local anesthetics, such as procaine, around the diseased tooth. Pericoronitis Pericoronitis occurs when the soft tissues around the crown of a mandibular wisdom tooth become inflamed due to incomplete eruption or obstruction. At the beginning of the inflammation, the patient feels painful swelling of the gums, and the pain is obvious when chewing and swallowing or opening the mouth, and the pain increases with the development of the disease; in severe cases, there may also be different degrees of inability to open the mouth, and even the teeth are closed. Treatment is mainly local treatment, commonly used saline and 2% hydrogen peroxide rinse local, and then placed iodine glycerin, preferably 1-3 times a day, and then rinse mouth with chlorhexidine mouthwash. If an abscess is formed, it should be promptly incised and drained. If there is redness, swelling and heat in the cheek, or even generalized fever and pain, antibiotics and anti-inflammatory painkillers can be used, and the commonly used drugs are also broad-spectrum antibiotics and methotrexate (metronidazole), etc. Regardless of periapical or pericoronitis, if the condition is not controlled, it is easy to form oral and maxillofacial interstitial infection, then intravenous antibiotics can also be considered, and the doctor should choose the drug according to the patient’s condition, such as penicillin, etc. To sum up, the first thing to consider when you have a toothache is to consult a specialist for local treatment first and only use antibiotics and painkillers if necessary. There are some drugs on the market that claim to be able to treat toothache and periodontal disease, but in fact professional dentists basically do not prescribe these drugs, and relying on drugs alone without local treatment will not solve the problem, and will even delay the condition.