Tooth pain often feels worse at night. There are practical reasons for that — you are lying down, the room is quiet and there are fewer distractions — and there can be medical ones too. Some toothaches settle with simple measures until you can be seen. Others should not wait. This guide covers both.
Important: nothing in this article treats the cause of tooth pain. Temporary relief is a way to get through the night; an assessment is how you find out what is wrong and what to do about it.
Why toothache can be worse at night
When you lie flat, blood flow to the head changes and pressure around an inflamed tooth can increase. The pulse of a blood vessel near an inflamed pulp can become noticeable as throbbing pain. Being still and quiet also makes us more aware of pain, and grinding or clenching during sleep can add to the pressure.
Common causes of tooth pain
- Tooth decay reaching close to or into the pulp
- Pulp inflammation or infection that may lead to root canal treatment
- A cracked or fractured tooth, or a loose filling or crown
- Gum infection or an abscess at the root of a tooth
- Sinus pressure or a cold, which can make upper back teeth ache
- Sensitivity from exposed roots or recent dental work
- Bruxism — grinding or clenching, often during sleep
Because several of these cause similar symptoms, the only reliable way to identify the cause is an assessment. Our toothache page explains what we ask when you call.
Safe temporary measures
These may help you manage until you can be seen. They are not a cure and should not delay an assessment if the pain persists.
Rinse gently with warm salt water
A mild salt-water rinse can help clean the area and may soothe irritated gums. Do not use very hot water, which can make pain worse.
Keep your head raised
Using an extra pillow at night can sometimes reduce throbbing. If lying flat is clearly worse, that itself is worth mentioning when you call.
Over-the-counter pain relief, used as directed
Follow the label directions exactly, or ask a pharmacist what is suitable for you. Check with a doctor or pharmacist if you are pregnant, have a medical condition or take other medicines. Never place a tablet directly on the gum or tooth.
Avoid very hot or cold food and drinks and hard chewing
Hot, cold and pressure can each trigger pain. Soft, room-temperature food is easier on a sore tooth, and chewing on the other side eases pressure on a cracked or inflamed tooth.
Cold packs for swelling
If there is swelling on the outside of your cheek, wrap a cold pack in a cloth and hold it against the area for short periods. Do not apply heat to a swollen face — that can make it worse.
Traditional home remedies such as clove oil or placing garlic or aspirin next to the tooth are not a treatment and can irritate the gums. If you are unsure, ask us or a pharmacist.
Emergency warning signs — get medical help
Contact emergency services or go to an emergency department if you have any of the following:
- Difficulty breathing or swallowing
- Swelling spreading around your eye, jaw or neck
- Swelling in your mouth or under the jaw that makes swallowing or speaking difficult
- A fever with facial swelling
- Uncontrolled bleeding
In Australia, call 000 for an emergency. For urgent dental pain that is not life-threatening, call us on (07) 5563 1201 to discuss urgent dental care.
When a toothache should not wait
Book an appointment promptly if pain lasts more than a day or two, wakes you repeatedly, comes with swelling or a bad taste near a tooth, or keeps coming back. A tooth that has been painful for weeks is rarely improving on its own, and an assessment today is usually simpler than an emergency visit later.
Tooth pain that has not settled?
Call to discuss urgent dental care and appointment availability. Tell us when the pain started and whether you also have swelling.
Related: toothache assessment, urgent dental care, signs you may need root canal treatment.