Tooth pain at night: getting through until morning

Toothache has a habit of arriving at eleven at night. Some of that is real — lying flat sends more blood to your head, and pressure inside an inflamed tooth has nowhere to go — and some of it is that there is nothing left to distract you. Either way, here is how to get to morning, and how to tell when morning is too long to wait.

Why does it get worse when I lie down?

Blood pressure in the head rises when you are horizontal. If the nerve inside a tooth is already inflamed, that extra pressure has nowhere to escape, because the nerve sits in a sealed chamber of hard tissue. The same ache that was a background hum at your desk becomes the only thing you can think about at midnight.

What actually helps tonight?

Sleep propped up. An extra pillow or two keeps your head above your heart and takes the edge off the throbbing. It is the single change most people notice.
Cold on the outside of the cheek — fifteen minutes on, fifteen off. Never heat: warmth opens blood vessels and, if there is infection, encourages it to spread.
Over-the-counter pain relief, taken as directed on the label. Follow the packet, and your pharmacist or doctor if you take other medication.
A warm salt-water rinse — half a teaspoon in a glass — which soothes irritated gum without doing anything to the tooth itself.
Leave that side alone. No chewing on it, and go easy on very hot or very cold drinks.

What makes it worse?

Aspirin placed against the gum is the classic mistake — it burns the tissue and does nothing for the tooth, because painkillers work through your bloodstream, not by contact. Heat on the face is the other one. And leftover antibiotics from a previous illness are a poor idea: the wrong drug, the wrong dose, and a course too short to do anything but breed resistance.

When should I not wait for morning?

Pain is miserable but rarely dangerous. Swelling can be. Go to an emergency department — Grand River Hospital is the closest — rather than waiting for us if you have any of the following:

Difficulty breathing, swallowing, or speaking
Swelling spreading toward your eye or down your neck
You cannot open your mouth properly
A fever, or feeling generally unwell alongside the pain

Those signs point to an infection that has moved beyond the tooth, and that is a hospital matter before it is a dental one. More on that in facial swelling from a tooth.

What happens in the morning?

Call us at (519) 884-8594. We pick up voicemail from 8am and urgent calls come back first. Pain that wakes you at night is a reason to be seen, not a reason to wait and see — a tooth that hurts lying down is usually telling you the nerve is involved, and that does not settle on its own. Where the nerve has died, root canal treatment is usually what saves the tooth.

What to expect and what it costs is set out on our emergency and urgent care page.