Toothache at night: what to do, and when it is an emergency

01Why a toothache feels worse at night

Many people notice that tooth pain gets worse once they lie down. There are a few simple reasons. When you lie flat, more blood flows to your head, which can add pressure around an inflamed tooth.

There are also fewer distractions at night, so you notice the pain more. And if you clench or grind your teeth in your sleep, that pressure can make a sore tooth hurt more.

Night pain is a signal, not the problem itself. The cause is usually something a dentist needs to look at, such as a deep cavity, a cracked tooth, an infection, or irritated gums.

02Safe steps to get through the night

These steps will not fix the cause, but they may help you rest until you can call the office.

1. Rinse with warm salt water. Stir about half a teaspoon of salt into a glass of warm water. Swish gently and spit. This can help clean the area and soothe the gums.
2. Floss gently. A piece of food stuck between teeth can cause a surprising amount of pain. Floss carefully around the sore tooth.
3. Use a cold compress on the outside of your cheek. Wrap ice or a cold pack in a thin towel. Hold it on for about 15 minutes, then take a break.
4. Keep your head raised. Sleep with an extra pillow so your head is higher than your heart.
5. Take an over-the-counter pain reliever as directed on the label, if it is safe for you. Ask a pharmacist if you are not sure, especially if you take other medicines, are pregnant, or have health conditions.
6. Avoid triggers. Skip very hot, very cold, or sugary foods and drinks, and chew on the other side.

03What not to do

• Do not put aspirin or any pill directly on your gum or tooth. It can burn the gum tissue.
• Do not use heat on your face if you have swelling. Heat can make some infections spread.
• Do not try to pop a bump on your gum or poke at the tooth with sharp objects.
• Do not take more pain reliever than the label says, even if the pain is strong.

04When it is an emergency

Most toothaches can wait until the dental office opens. Some cannot. Call 911 or go to the nearest emergency room right away if you have:

• Swelling in your face or jaw that is spreading toward your eye or down your neck
• A fever along with tooth pain or swelling
• Trouble breathing or swallowing
• Bleeding from the mouth that will not stop with firm pressure
• An adult tooth that has been knocked out

A spreading dental infection can become serious quickly. Do not wait for morning if you have any of these signs.

If an adult tooth is knocked out

Pick it up by the top (the crown), not the root. If it is dirty, rinse it briefly without scrubbing. Keep it moist in a small container of milk and get care within an hour.

Time matters a lot for saving the tooth. Baby teeth should not be put back in.

05Common causes of nighttime tooth pain

A deep cavity

When decay reaches the inner layers of a tooth, it can cause sharp pain with sweets or cold, or a dull ache that comes and goes. Caught early, a cavity can often be treated with a filling.

Gum irritation

Gingivitis is early gum inflammation. It can make gums sore, red, and likely to bleed. Food trapped under the gum line can also cause a throbbing ache.

An infected tooth

Pain that throbs, keeps you awake, or lingers long after hot or cold can mean the nerve inside the tooth is inflamed or infected. This may need a root canal or other treatment.

Clenching or grinding

If several teeth ache in the morning, or your jaw feels tired, you may be clenching at night. A dentist can check for signs of wear.

06What to do in the morning

Call Americana Family Dental as early in the day as you can. The front desk will look for the soonest time open. The office is open Monday through Friday, 8 AM to 4 PM, and closed on weekends. If your pain starts on a Friday night, use the safe steps above, watch for the warning signs, and call first thing Monday.

When you call, be ready to describe where it hurts, how long it has hurt, and what makes it better or worse. Dr. Wael Sadek will examine the tooth and explain what is causing the pain. If the cause is decay, you can read about tooth-colored fillings and cavity repair. To reach the office, visit our contact page for phone, address, and hours or call (407) 850-0133.

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