There is a particular misery to toothache at night. The house is quiet, the practice is closed, and the pain that was manageable at teatime is now the only thing in the world. It is not your imagination that it feels worse after dark, and there are practical things that help until morning.
This is written for someone reading it at two in the morning, so the useful parts are near the top.
On this page
- What helps right now
- Why toothache is worse at night
- What not to do
- When to call NHS 111 rather than wait
- When to go to A&E
- In the morning
- What is probably causing it
- The bottom line
What helps right now
- Take painkillers exactly as the packet directs. Do not exceed the stated dose. If you can safely take both, ibuprofen and paracetamol are sometimes used together or alternated, but check the packet and any advice you have been given, and speak to a pharmacist if unsure.
- Prop your head higher. Extra pillows, or sleep semi-upright in a chair. This genuinely helps, and the reason is in the next section.
- Cold compress against the cheek, twenty minutes on and twenty off. A bag of frozen peas wrapped in a tea towel works well.
- Warm salt-water rinse, gently, which can soothe irritated gum tissue.
- Avoid triggers: nothing very hot, very cold or very sweet, and chew on the other side entirely.
- Keep the area clean, brushing gently. Food trapped against an inflamed tooth makes things worse.
- If a cavity is obviously trapping food, gentle rinsing may relieve pressure. Do not dig at it.
Why toothache is worse at night
Three reasons, and knowing them helps you work with rather than against the problem.
Lying flat increases blood flow to your head, which raises pressure inside an inflamed tooth. The pulp sits in a rigid chamber with nowhere to expand, so any increase in pressure is felt sharply. This is why propping yourself up helps.
There are fewer distractions. During the day, activity occupies your attention. At night there is nothing between you and the pain.
Saliva flow reduces during sleep, and the natural rhythm of certain hormones may also play a part in how pain is perceived overnight.
What not to do
- Never place aspirin against the gum. This old remedy burns the soft tissue and does nothing for the tooth. Aspirin works when swallowed, not applied.
- Do not exceed the stated dose of any painkiller, however tempting.
- Do not apply heat to the face if there is any swelling, as it can encourage infection to spread.
- Do not attempt to open or drain a swelling yourself.
- Do not use leftover antibiotics from a previous course. Our post on whether antibiotics cure tooth infections explains why they cannot resolve this anyway.
- Do not use clove oil undiluted on the gum, which irritates tissue. It has a mild numbing effect on a tooth but is easily overdone.
When to call NHS 111 rather than wait
Do not simply endure the whole night if the pain is severe. Call NHS 111 if:
- The pain is unmanageable despite appropriate painkillers
- You have facial swelling
- You have a fever or feel generally unwell
- You cannot sleep at all because of it
They can give advice and direct you to urgent dental services in the area.
When to go to A&E
Go straight to A&E, or call 999, if:
- Swelling is affecting your breathing or swallowing
- Swelling is spreading towards your eye or closing it
- You cannot open your mouth properly
- You have a high fever and feel seriously unwell
- Bleeding will not stop
These are uncommon, but they are the situations where a dental problem has become a medical emergency, and hours matter. Our post on what counts as a dental emergency covers this in more detail.
In the morning
Ring us as early as you can on 01255 422506. Genuine emergencies are prioritised, and describing what has happened takes two minutes.
Please do not let the pain settle and then cancel. Toothache that eases has not necessarily resolved; sometimes it means the nerve inside the tooth has died, which does not fix the problem and often precedes an abscess.
You do not need to be a registered patient to ring, and that applies equally to visitors staying in the area. Our page on emergency dental treatment explains how it works.
What is probably causing it
Severe night-time toothache is most often one of these:
- An infected or dying nerve inside the tooth, usually from deep decay. Treatment is root canal treatment or, if the tooth cannot be saved, extraction.
- A dental abscess, a collection of infection at the root, which typically throbs and may cause swelling.
- A cracked tooth, often painful specifically on biting and releasing.
- A deep cavity irritating the nerve.
- An exposed socket after an extraction, where our post on dry socket explains the pattern.
Note that none of these resolve on their own. The pain may fluctuate, but the underlying cause needs treating.
The bottom line
Prop your head up, take painkillers as directed, use a cold compress, avoid hot, cold and sweet, and never put aspirin on your gum. Call NHS 111 if the pain is unmanageable or there is swelling, and A&E if swelling affects breathing, swallowing or vision.
Then ring us first thing on 01255 422506. Night-time toothache is a tooth asking for treatment, not something to be endured until it settles.
This article is general information rather than personal dental advice. Every mouth is different, so please speak to your dentist about your own teeth.