CBD Reduced Acute Toothache in a Small Randomized Clinical Trial
A small randomized clinical trial found that a purified cannabidiol (CBD) medicine reduced acute toothache more effectively than placebo, pointing to a possible nonopioid option for short-term dental pain. The findings, however, do not yet establish CBD as a proven replacement for opioids or standard dental pain treatments.
The study, published in the Journal of Dental Research in 2024, included 61 adults with moderate to severe toothache. Researchers randomly assigned participants to receive a single oral dose of either 10 milligrams per kilogram of CBD, 20 milligrams per kilogram, or a placebo. The CBD came from Epidiolex, a prescription formulation containing purified cannabidiol.
Participants were monitored for three hours and reported their pain at regular intervals. Both CBD groups experienced significantly greater pain reduction than the placebo group. Median pain reduction reached approximately 73% to 77% from baseline at 180 minutes after dosing.
The higher dose appeared to work more quickly: significant pain relief began after about 15 minutes in the 20-milligram-per-kilogram group, compared with approximately 30 minutes in the lower-dose group. Both doses reached their greatest measured effect at around three hours.
The researchers also assessed bite force, an indirect measure of how comfortably participants could use their teeth. Bite force increased in both CBD groups, with the higher-dose group showing a statistically significant improvement compared with placebo at 90 and 180 minutes.
Using the number needed to treat—a measure estimating how many patients must receive a treatment for one additional patient to achieve at least 50% pain relief—the study reported values of 3.1 for the lower CBD dose and 2.4 for the higher dose. Those figures suggest a potentially meaningful effect, but they should not be interpreted as a direct comparison with opioids because the trial did not include an opioid treatment group.
CBD was not free of side effects. Compared with placebo, participants who received CBD were more likely to report sedation, diarrhea, and abdominal pain. The study found no significant differences in other psychoactive or mood-related effects during the short monitoring period.
The researchers characterized the trial as phase 2A evidence and called for larger studies, including research examining postoperative dental pain and longer follow-up. The trial was also limited by its small sample, single-dose design, and three-hour observation window. It therefore cannot determine how CBD compares with established nonopioid treatments, how safe repeated use would be, or whether the results apply to commercially sold hemp-derived CBD products.
That distinction matters. Epidiolex is FDA-approved for certain severe seizure disorders, not for dental pain. The FDA’s information on cannabis-derived products notes that unapproved CBD products have not been evaluated for their effectiveness, appropriate dosage, drug interactions, or product quality. CBD can also cause sedation, interact with other medicines, and pose risks such as liver injury.
For now, CBD remains an investigational option for acute toothache rather than an established dental analgesic. Current American Dental Association guidance generally places nonopioid medicines such as nonsteroidal anti-inflammatory drugs, alone or with acetaminophen when appropriate, ahead of opioids for acute dental pain. Patients should seek definitive dental treatment and consult a dentist or clinician before using CBD, particularly if they take other medications or have liver disease.
