Tooth pain at night, and what to do until the clinic opens

Why a toothache gets worse at night

Nothing new happens inside the tooth at eleven at night. What changes is you. Three things are usually at work, and none of them mean the problem has suddenly become dangerous.

The first is position. When you lie flat, more blood reaches your head. The nerve inside a tooth sits in a sealed chamber of hard tissue with no room to swell, so the extra pressure has nowhere to go. You feel that as throbbing.

The second is distraction. All day there is work, traffic, family, a phone. At night there is a dark room and one signal to pay attention to.

The third is timing. Most people take something for the pain in the evening. It wears off in the small hours. The pain has not grown. The cover has gone.

Many people also clench or grind in their sleep without knowing it, which loads a cracked or inflamed tooth for hours at a stretch.

What the kind of pain is telling you

Sharp pain with cold or sweet, gone in seconds

This is usually sensitivity or early decay through the enamel. It arrives with the trigger and leaves with it. It is also the cheapest stage there is. A filling is a single short appointment. The same tooth left alone for a year becomes a root canal.

Deep, steady throbbing that keeps you awake

Pain that starts on its own, lasts for minutes or hours, and wakes you up usually means the nerve inside the tooth is badly inflamed or infected. Painkillers dull it. They do not treat it. This is the pain that most often needs root canal treatment before it settles for good.

Pain when you bite down

A tooth that is quiet at rest but sharp under pressure often has a crack, a filling sitting slightly high, or infection at the tip of the root. Chew on the other side until someone looks at it.

Swelling of the gum, or a sudden salty taste

A lump beside the tooth, or a salty taste that appears out of nowhere, suggests an abscess that is draining. The pain often drops sharply at that moment. That feels like recovery. It is not.

Pain that stopped by itself

Nerves die. When the nerve inside an infected tooth finally dies, the pain frequently disappears completely, and people take that as the problem resolving itself. The infection carries on quietly at the root and comes back later, usually larger. Get it seen even though it no longer hurts.

What genuinely helps until morning

• Sleep propped up on two or three pillows. Keeping your head above your heart is the single most useful thing on this list, and it is free.
• Take an ordinary over-the-counter painkiller, following the instructions on the packet. Take it before you go to bed rather than waiting for the pain to peak. If you take other medication, ask the pharmacist first.
• Hold something cold against the outside of the cheek, twenty minutes on and twenty minutes off.
• Rinse with warm salt water, half a teaspoon in a glass. Hold, then spit. Do not swallow it.
• Eat soft, lukewarm food and chew on the other side.
• Avoid ice water, very hot tea and sugary drinks. Karak at two in the morning will not help.

What to avoid, including two things people still do

Do not hold an aspirin against the gum. Aspirin works once it is swallowed and absorbed, not through the surface of the gum. A tablet held against soft tissue burns it — a white, raw patch of dead gum that then has to heal on its own, on top of the toothache you already had. Swallow painkillers.

Do not put heat on a swollen face. Warmth opens blood vessels and encourages a spreading infection to spread further. Cold on the outside of the cheek is the safe choice. Heat is for a tired jaw muscle, never for a swollen one.

Three more, briefly. Do not dig at the tooth with a pin, a needle or a sharpened toothpick. Do not take leftover antibiotics from an old course; the dose is wrong, the drug may be wrong, and antibiotics never repair a tooth on their own. Do not hold spirits or neat clove oil against the gum, which burns tissue much as aspirin does.

The signs that mean go now, not in the morning

Most toothache can safely wait one night. A small number of situations cannot, and they are worth knowing so that you can stop worrying about the rest. Go to a hospital emergency department the same night if any of these apply.

• Swelling of the face itself, not only the gum.
• Swelling spreading towards or closing the eye, or spreading under the jaw or into the neck.
• Any difficulty swallowing, or any difficulty breathing.
• Fever, shivering, or feeling generally unwell alongside the tooth pain.
• A tooth knocked out, loosened or broken by an injury.

These are uncommon. They are also the situations where hours matter, because the spaces under the jaw and around the eye connect onward to places an infection should never reach. A dental clinic is the right place for a toothache. A hospital is the right place for a spreading infection at two in the morning.

What the morning appointment actually involves

A dental check-up takes about twenty minutes. What it buys is a diagnosis: which of the kinds of pain above you have, what caused it, and what it costs to put right before anything is started. A filling is usually a single short visit. An extraction is quick once you are numb. A root canal takes one or two visits, and a back tooth usually needs a crown afterwards. The whole list is on the prices page, and it does not change once you are in the chair. If the tooth can be saved, we say so, even though taking it out is quicker for us.

We are open Monday to Friday, 9am to 9pm, and Saturday, 12pm to 8pm. We are closed on Sunday. If the pain begins on a Saturday night, Sunday is the day to use the advice above and a pharmacy, unless one of the warning signs appears, in which case go to hospital rather than wait for us on Monday.

Toothache is worse at night because you are lying down and there is nothing else to think about, not because something terrible has happened in the last hour. Sleep propped up, take something sensible, and get it looked at. Sometimes the answer is a small filling. Sometimes the answer is that nothing needs doing at all.

Common questions