Toothache at night: common causes and what to do until morning

Toothache during the day is bearable; at night it often becomes much worse. Lying down sends more blood to the head and raises the pressure inside the tooth's pulp, there is nothing to distract you, and the clinic is closed. This article helps you recognise the likely cause, get through the night safely, and know when to seek emergency care instead of waiting for morning.

Common causes

• Deep decay, inflamed pulp: sharp, throbbing pain that comes on by itself, worse lying down and with hot or cold food, sometimes spreading to the ear or temple. This is the most common cause of night-time toothache. See What is root canal treatment?.
• Abscess at the root tip: constant pain, the tooth feels "high" when biting, swollen gum, possibly fever. The pulp has usually died some time before.
• An impacted wisdom tooth or infected gum flap: pain at the back corner of the jaw, swelling, difficulty opening. See Impacted wisdom teeth.
• A cracked tooth: sharp pain on biting and releasing, hard to pin down to one tooth.
• A gum abscess: swollen, painful gum with pus, a loose tooth.
• Food wedged between two teeth: pressure pain that stops once it is removed.
• Grinding: aching across the whole jaw and tired muscles on waking.
• Sinusitis: several upper back teeth aching at once, worse when bending forward, with a blocked nose.

Safe ways to get through the night

• Over-the-counter pain relief such as paracetamol, at the dose on the packet and never above the daily maximum. If you have liver, kidney or stomach problems or take other medicines, ask a pharmacist or doctor before taking anti-inflammatories.
• Rinse with warm salt water a few times, especially if you suspect trapped food or gum inflammation.
• Floss gently to remove food wedged between teeth.
• Sleep with your head raised to reduce pressure on the tooth.
• Cold compress on the cheek for 15 minutes if there is swelling. Do not use heat.
• Avoid very hot, cold or sweet food, and chew on the other side.
• Note which tooth hurts, what the pain is like and when it comes, to tell the dentist in the morning. If you have been to Asahii Dental Clinic before, your earlier X-rays and records are still in the clinic's system for the dentist to compare.

What not to do

• Do not place painkillers directly on the tooth or gum: they burn the soft tissue.
• Do not take leftover antibiotics from a previous course: wrong type, wrong dose, they mask the symptoms and increase resistance.
• Do not pick at the tooth with toothpicks or pins.
• Do not apply garlic, spirits or hot oils to the tooth or gum.
• Do not apply heat to a swollen face: it can spread the infection.
• Do not keep putting up with it night after night: painkillers only hide the symptom while the cause gets worse.

When it is an emergency: go now, do not wait for morning

• Swelling spreading quickly to the cheek, down the neck, under the jaw or up towards the eye.
• Difficulty swallowing or breathing, or being able to open the mouth only slightly.
• High fever with a swollen face.
• Bleeding that will not stop after an extraction or injury.
• A tooth broken or knocked out in an accident with a head injury.

These signs suggest an infection that may be spreading and needs treatment at a facility with emergency care, including a hospital, that same night.

The next morning: book an appointment

Even if the pain eases after taking medicine, see a dentist soon. Pain that stops by itself after a few days of severe pain can mean the pulp has died; the infection goes quiet and comes back worse. At the visit the dentist examines you, tests the pulp and takes X-rays to find the true cause, because the same kind of pain can come from several different teeth. Only an examination in person can give a diagnosis. Asahii is open every day of the week from 08:30, Saturdays and Sundays included, so a painful night at the weekend does not mean two more days of waiting; when you book by hotline, Zalo or the Mini App, say that you are in significant pain so you are given an early slot.

See our general dentistry page or book an appointment. If the pain is severe, call the clinic's hotline, 0928 888 121, for an early slot.