A toothache at night often feels worse because lying down increases pressure in the blood vessels around an inflamed tooth, and there’s little to distract you. To get through the night, take over-the-counter pain relief if it’s safe for you, keep your head raised, use a cold pack on the outside of your cheek and call a dentist first thing in the morning.
Pain that wakes you up is a sign the nerve inside the tooth may be inflamed or infected, so it’s worth being seen soon. This guide explains how to manage the pain safely overnight. For other urgent problems, see our dental emergency guide.
Do you need a hospital tonight?
Most toothaches can be managed at home until a dental clinic opens. Call 000 or go to your nearest hospital emergency department if you have:
- difficulty breathing or swallowing
- swelling spreading to your eye, neck or the floor of your mouth, or under your tongue
- a high temperature with facial swelling, or you feel very unwell
- bleeding that won’t stop after 15–20 minutes of firm pressure
- a possible broken jaw, or pain after a knock to the head with loss of consciousness, vomiting or confusion
If you’re unsure whether you need to be seen tonight, call healthdirect on 1800 022 222. Registered nurses answer 24 hours a day, seven days a week.
Why toothache at night feels worse
Several things combine to make dental pain more noticeable after dark:
- Lying flat. More blood flows to your head when you lie down, which increases pressure inside an already inflamed tooth.
- Fewer distractions. Without work, screens and conversation, your brain pays more attention to pain signals.
- Grinding and clenching. Many people clench their teeth in their sleep, which can aggravate a sore or cracked tooth.
- Food earlier in the evening. Sugary, hot or cold food and drinks at dinner can set off a sensitive tooth that then keeps aching.
How to ease the pain overnight
- Take pain relief if it’s safe for you. Over-the-counter pain relief such as paracetamol or ibuprofen, taken as directed on the pack, can help. Ask a pharmacist if you have other health conditions or take other medicines.
- Rinse with warm salty water. Dissolve half a teaspoon of salt in a glass of warm water, swish gently and spit it out.
- Check for trapped food. Floss gently on both sides of the sore tooth. A trapped piece of food can cause a surprising amount of pain.
- Raise your head. Sleep propped up on an extra pillow or two to reduce the throbbing.
- Use a cold pack on the outside. Wrap ice or a cold pack in a cloth and hold it against your cheek for 10–15 minutes at a time.
- Protect the area. Cover a sharp edge or broken filling with sugar-free gum or dental wax, and chew on the other side.
What not to do
- Don’t put aspirin or any tablet directly on the gum. It can burn the soft tissue.
- Don’t use a heat pack on your face, especially if there’s any swelling.
- Don’t take more than the pack allows, and check cold and flu products so you don’t double up on the same medicine.
- Don’t take leftover antibiotics or someone else’s. Antibiotics should only be taken if a dentist or doctor prescribes them.
- Don’t poke at the tooth or gum with pins or other sharp objects.
What your toothache might be telling you
Only an examination and X-rays can confirm the cause, but the type of pain can give some clues:
- A short, sharp twinge with cold that fades in seconds may be sensitivity, gum recession or early decay.
- A throbbing ache that lingers, starts on its own or wakes you often means the nerve is badly inflamed. This usually won’t settle by itself.
- Pain when you bite, with swelling or a bad taste can point to a dental abscess.
- A dull ache at the back of the jaw with sore gums may come from a partly erupted wisdom tooth.
- Aching in several upper back teeth with a blocked nose can be linked to a sinus infection.
- A tired, aching jaw on waking may be a sign of night-time clenching or grinding.
If severe pain suddenly stops, don’t assume the problem has gone. In some cases it means the nerve has died, and an infection can still develop. Book a check-up anyway.
Getting treatment in the morning
Call as soon as the clinic opens and describe your symptoms. Our emergency dentist in North Sydney aims to see urgent problems as soon as possible, often on the same day.
Your dentist will find the cause and focus on relieving the pain first. Depending on what they find, treatment may include a temporary dressing, a dental filling or root canal therapy to remove an inflamed or infected nerve. If a tooth can’t be saved, removal may be discussed. Your dentist will explain your options, risks and costs before going ahead.
Preventing toothache at night
Regular check-ups at our North Sydney practice help find decay and cracked fillings before they reach the nerve. Don’t ignore early signs such as sensitivity to cold, pain when biting or a tooth that aches after sweet food. These are much easier to treat early than at 2am.
Frequently asked questions
Why does my toothache get worse when I lie down?
Lying flat increases blood flow and pressure around the head, which can make an inflamed tooth throb more. Sleeping with your head raised on an extra pillow may help.
Should I go to hospital for a toothache at night?
Go to hospital or call 000 if you have difficulty breathing or swallowing, swelling spreading to your eye or neck, or you feel very unwell. For advice on other symptoms, call healthdirect on 1800 022 222.
Can I sleep with a toothache?
Many people can get some rest by taking over-the-counter pain relief as directed if it’s safe for them, keeping their head raised and using a cold pack on the outside of the cheek. Book a dental visit for the next day.
What if my toothache stops on its own?
Pain that suddenly stops can mean the nerve inside the tooth has died. The tooth may still become infected, so it’s important to have it checked by a dentist.
Need help now?
North Sydney Dentistry is at Level 1, Suite 102/71 Walker St, North Sydney, a two-minute walk from North Sydney station. We’re open Monday to Friday, 9am to 6pm, and keep time aside for urgent problems where we can. Call (02) 8090 1108 or book online.
This article is general information only and is not a substitute for advice from your own dentist or doctor. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
