Tooth pain at night: why it gets worse and what helps

Why your tooth hurts more at night

Tooth pain feels worse at night mostly because nothing else is keeping your mind busy, and because lying down sends more blood to your head. That extra pressure can make an inflamed tooth throb.

The pain itself is not made up. A toothache means something is wrong inside or around the tooth. Common causes are a deep cavity, a cracked tooth, a loose or old filling, a gum infection or an infection at the tip of the root. Cleveland Clinic says toothaches that come from cavities or infections do not heal on their own, so they need a dentist.

Night pain that throbs, wakes you up or does not stop is a bigger warning sign than a quick zing from something cold. It often means the nerve inside the tooth is irritated or infected.

Cleveland Clinic notes that tooth pain can also spread. You may feel it in your jaw, ear or head, which is why it can be hard to say which tooth is the problem. Night is often when you first notice it, because the day's noise is gone and you finally sit still.

What you can do tonight

These steps will not fix the cause. They can help you get through the night until you see a dentist.

Sleep with your head raised on an extra pillow. This lowers the pressure in your head. Brush gently and floss around the sore tooth to remove any food stuck there. Skip very hot, very cold and very sweet foods and drinks, and chew on the other side.

Take a few minutes before bed to look at the sore spot in a mirror. Do you see a dark hole, a chip, a red or swollen gum or a bump? Write down what you see and when the pain started. This helps the dentist work faster, because tooth pain is hard to describe from memory the next morning.

If you wear a night guard, wear it. If you clench your teeth when you are stressed, try to relax your jaw: lips together, teeth slightly apart, tongue resting on the roof of your mouth.

• Rinse with warm salt water: half a teaspoon of salt in a cup of warm water. Swish for 30 seconds and spit.
• Hold a cold pack on your cheek, outside the mouth, for 15 minutes at a time.
• Avoid putting aspirin or any pain pill directly on your gum. It can burn the tissue.
• Skip alcohol and sugary snacks before bed.

Pain relievers that work

Over-the-counter pain medicine is the best bet for most adults. A review of studies covered by Case Western Reserve University found that 400 mg of ibuprofen taken with 1,000 mg of acetaminophen worked better for dental pain than opioid medicines, with fewer side effects.

That does not mean everyone should take that combination. Ibuprofen is not safe for everyone, including people with stomach ulcers, kidney disease, some heart conditions or those who take blood thinners. Acetaminophen has a daily limit too. Read the label, and ask your doctor or pharmacist if you are not sure what is safe for you.

Pain pills help the pain. They do not treat the problem. If you need them every night, that is your sign to book a visit.

A good habit is to take the first dose about 30 minutes before you plan to sleep, so the medicine is working when you lie down. Follow the label for how often you can repeat it. Never take more than the label says, and do not mix several products that contain the same drug, such as two cold medicines that both have acetaminophen.

Signs your toothache is more serious

Pay attention to how the pain behaves. Pain that lingers for more than a minute after a hot or cold drink often means the nerve is inflamed. Pain that throbs with your heartbeat points to an infection. Pain only when you bite points to a crack or a bite problem. You do not have to figure it all out. Just tell the dentist what you notice.

Some symptoms say the problem is more than a sore tooth. Call a dentist the same day, or go to an emergency room if you cannot reach one, if you have:

• A fever or chills with the pain
• Swelling in your cheek, jaw or under your eye
• A bad taste or pus in your mouth
• Pain that medicine does not touch
• Bleeding that does not stop

Why waiting does not make it better

Many people live with a toothache for a few days hoping it goes away. Sometimes the pain does stop. That can be a bad sign, not a good one. When the nerve inside the tooth dies, the pain can fade while the infection stays.

Mayo Clinic explains that a tooth abscess, a pocket of pus from infection, can spread to the jaw, neck or other parts of the body. If you have trouble breathing or swallowing, that is an emergency, so go to the ER or call 911 right away.

Dentists also say that the earlier we treat a tooth, the more of it we can often save. A small cavity needs a filling. A neglected one can need a root canal or an extraction.

Think of the nerve inside a tooth like a wire in a tight space. When it swells from infection, there is nowhere for the pressure to go, which is why the pain can be so strong. Opening the tooth to release that pressure is often the fastest way to get relief.

If you have diabetes, a heart condition or a weak immune system, take tooth pain even more seriously. Infections can be harder to control, so call a dentist the same day.

What a dentist will do

At the visit, your dentist asks when the pain started, what makes it better or worse, and what you have tried. Then they check the tooth, tap on it, test it with cold and take an X-ray. The goal is to find the exact tooth and the exact cause.

Depending on what we find, treatment can be as simple as a filling, a crown, a gum cleaning or a root canal. Sometimes antibiotics are used if there is a spreading infection. Pulling the tooth is the last choice, not the first.

Most people feel relief after treatment starts. The numbing medicine we use lets you rest while the dentist works.

After treatment, your dentist will tell you what to expect and what to watch for. Ask about foods to avoid, how long numbness lasts and how to care for the tooth at home. Ask also how to prevent the same problem from coming back. A good plan includes regular exams, so the next problem is caught while it is small.

When to call KDA

If tooth pain is keeping you up at night, do not wait for it to get worse.

KDA lists emergency care 24/7. If you are in pain, call us at 305-271-1421 and tell us what is going on. Our regular office hours are Monday to Friday, 8:00 AM to 5:00 PM, and we are closed Saturday and Sunday.

You will find us at 8833 SW 107th Ave, Miami, FL 33176, in the Kendall Mall. We have served South Florida since 1973. We take digital X-rays and 3D scans in the office, so we can see what is wrong the same visit. We accept most dental insurances and most Medicare supplemental plans, and financing is available.

Do not treat a bad night as a one-off. If a tooth woke you up once, there is likely a reason, and it tends to come back. Booking a visit this week usually costs less than a night in pain next week.

Common questions

This article is general information, not medical advice. Your dentist will confirm what is right for you at your exam. General information checked against: my.clevelandclinic.org, case.edu, dentaquest.com.