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

Tooth pain has a particular cruelty to it at two in the morning. It is worse than it was at lunchtime, there is nobody to ring, and the hours until a practice opens feel considerably longer than they are.

Here is what actually helps overnight, what makes things worse, and the small number of signs that mean you should not be waiting for morning at all.

Why it gets worse at night

It is not your imagination and it is not that you are being dramatic.

Lying flat sends more blood to your head, which increases pressure inside an already inflamed tooth. There is also nothing competing for your attention: no work, no conversation, no television. Pain you could ignore at midday has the room to itself at midnight. And if you took something earlier in the evening, it may simply be wearing off.

What genuinely helps until morning

• Sleep propped up. An extra pillow or two keeps your head above your heart and takes some of the pressure off. This is the single most useful thing on this list and it costs nothing.
• Pain relief, taken properly. Follow the label, and if you are unsure what is safe alongside your other medication, a pharmacist can tell you.
• A cold compress on the outside of the cheek. Twenty minutes on, twenty minutes off. Cold reduces swelling and dulls the ache.
• Warm salt water rinses. Half a teaspoon in a glass of warm water. Gentle, and it helps if there is debris or irritation around the gum.
• Keep the area clean. Brush gently, even though you will not want to. Food trapped against an inflamed tooth makes it worse.
• Avoid very hot, very cold and very sweet things. All three will find an exposed nerve.

What makes it worse

• Aspirin held against the gum. This is an old remedy and it is genuinely harmful. Aspirin is acidic and will burn the soft tissue, leaving you with a chemical ulcer on top of a toothache. Swallow pain relief, do not pack it.
• Heat on a swollen face. A hot pack feels soothing for a moment, then draws infection outwards and makes swelling worse. Use cold.
• Alcohol. It does not numb a tooth, it disturbs sleep, and it does not mix well with pain relief.
• Waiting to see if it settles. Pain that wakes you is a tooth telling you something is going on inside it. It sometimes quietens for a day or two, which is not the same as getting better.

The signs that mean do not wait

Most toothache can wait until the morning. Some cannot.

Go to your nearest hospital emergency department tonight if you have swelling spreading across your face or closing your eye, if you are having trouble swallowing or breathing, or if you have a fever alongside the pain. Those point to an infection that is moving, and that is treated as urgent in any hospital in the country.

If a tooth has been knocked out completely, time matters enormously. Hold it by the crown rather than the root, rinse it in milk if it is dirty, and get to a dentist within the hour if you possibly can.

What to do in the morning

Ring as early as you can and describe what happened, when it started and what the pain is like. That tells us how quickly you need to be seen, and it is more useful than trying to self diagnose over the phone.

If you are an existing patient here, say that it kept you awake. We keep room in the day for exactly this, and a night without sleep moves you up the list.

One honest note about cost

People put off ringing because they are worried about what it will cost before they even know what is wrong. We would rather you rang.

You will be told what the appointment involves and what it costs before anything is done, and if money is the thing standing in the way, say so. There are usually options, and they are easier to arrange at the start than halfway through.

Related reading: our emergency dentistry page. how dental quotes actually work.