<s>[INST] My grandson is experiencing severe toothache due to excess teeth & is due to have a removal soon.He is a 11 yr old the size of a small adult his mother has given him 4 doses 4hrs apart during the day of 1 ibuprofen 200mg tablet but is still in severe pain what would you advise? [/INST] Hi. Thanks for the query. I have gone through your query and can understand your concerns. As per your complaint it seems that in case of he is experiencing severe pain in spite of giving 4 doses of Ibuprofen with no relief then it can be due to excessive pressure over the nerves in the area under the root tips of the tooth caused by the pus formed due to infection that is leading to dental abscess formation. In this case the removal of the tooth can only resolve the pain completely. You should consult his treating dentist should be consulted soon, and an early extraction can be planned to relieve his pain permanently. As of now you can give him higher painkiller like TRAMADOL to relieve pain as it can relieve severe pain. Hope this information helps. Thanks and regards. Chat Doctor.  </s>