Toothache at night: what to do before you can see a dentist

Dental pain often flares up at night. Lying down increases blood pressure in the head, which can make throbbing pain feel worse, and there are fewer distractions to take your mind off it. The good news: there are safe, simple steps that can bring meaningful relief until you can be seen.

Immediate steps at home

Rinse gently with warm salt water (half a teaspoon of salt in a glass of warm water) to soothe the tissues and clear any food debris. Take an over-the-counter pain reliever such as ibuprofen or paracetamol according to the label — used correctly, ibuprofen also reduces inflammation, which is often the underlying cause of the throbbing.

Cold compress

Apply a cold compress or a bag of frozen peas wrapped in a thin cloth to the outside of the cheek in 15-minute intervals. This reduces swelling and slows nerve conduction, which dulls the pain. Never place ice directly on the tooth itself.

Sleep with your head elevated

Prop your head up with an extra pillow, or sleep in a reclined chair. This reduces blood flow to the tooth and often eases the throbbing enough to fall asleep. Avoid lying flat on the affected side.

What to avoid

Do not place aspirin directly on the gum — it burns the tissue and creates a chemical ulcer. Avoid very hot or very cold foods and drinks. Do not use a heat pack on the face if there is any swelling — heat can spread infection. And do not ignore the pain hoping it will pass; toothache is a signal, not the problem itself.

What might be causing it

The most common causes are a deep cavity that has reached the nerve, a cracked tooth, an abscess (a pocket of infection at the root tip), a wisdom tooth pressing against its neighbour, or sinus pressure referring pain to upper teeth. Only an exam and, usually, an X-ray can tell them apart — but the treatment for each is very different, which is why self-diagnosis rarely helps.

When to call us urgently

Severe pain that isn't controlled by over-the-counter medication, facial swelling, fever, difficulty swallowing or breathing, or a knocked-out tooth all need immediate care. Call our emergency line and we'll see you the same day. A knocked-out adult tooth in particular has the best chance of survival if it's replanted within the first hour.