Why toothache gets worse at night, and what to do in Glasgow

Why toothache feels worse at night

The biggest culprit is simply lying down. When you are upright during the day, gravity helps keep the blood pressure in your head slightly lower. When you lie flat, more blood flows towards your head, and the pressure inside and around an inflamed tooth rises. If the nerve inside the tooth is already irritated, that extra pressure is often enough to turn a dull ache into a pounding, throbbing one.

Night also strips away distraction. During the day your brain is busy with work, conversations, traffic and a hundred small tasks, so pain has to compete for attention. At night there is nothing else to focus on, and the same pain simply feels louder.

A few other things pile on top. Painkillers taken earlier in the day wear off in the small hours. Some people clench or grind their teeth in their sleep, which aggravates a tooth that is already sore. And if your pain is connected to your sinuses, lying down lets congestion build up and press on the roots of your upper back teeth.

What might be causing it

Toothache that flares up at night can have several causes, and you cannot reliably tell which one you have from the pain alone. Tooth decay that has reached, or is getting close to, the nerve inside the tooth often starts as sharp pain with hot, cold or sweet things, then becomes a lingering throbbing ache as the inflammation builds. A dental abscess, which is an infection at the root of a tooth or in the gum, tends to cause constant throbbing pain, sometimes with swelling, a bad taste in the mouth, or a tooth that is tender to bite on.

A cracked tooth or a lost filling can leave the sensitive inner part of the tooth exposed. A wisdom tooth pushing through can leave the gum over it swollen and sore. And gum problems or night-time grinding usually cause a duller, more general ache rather than pain in one tooth.

Here is the honest part. Pain that wakes you from sleep, or stops you falling asleep in the first place, is one of the signs dentists take most seriously. It often means the nerve inside the tooth is inflamed or infected, and that will not settle on its own with painkillers. It usually needs treatment.

Safe ways to ease the pain tonight

While you decide what to do next, there are a few things that genuinely help. Take over-the-counter painkillers, used exactly as the packet directs. Paracetamol suits most people. Ibuprofen often works well for dental pain, but it is not suitable for everyone, including some people with asthma, stomach problems or certain other conditions, and it is not usually recommended in pregnancy. If you are unsure what is safe for you, ask a pharmacist first, and never take more than the stated dose just because the pain is bad.

Try a cold compress. A bag of frozen peas or an ice pack wrapped in a tea towel, held against the outside of your cheek for about 15 minutes at a time, can take the edge off pain and swelling. Do not put ice directly on your skin.

Sleep propped up. An extra pillow or two keeps your head above the level of your heart, which reduces the blood pressure effect described above. Many people find this alone makes the throbbing noticeably more bearable.

Rinse with lukewarm salt water. Dissolve a teaspoon of salt in a glass of warm water, rinse gently and spit it out. Do not swallow it. This can soothe sore gums, especially around a wisdom tooth.

Finally, be kind to the tooth. Avoid very hot, very cold or sugary food and drink, stick to softer foods, and chew on the other side of your mouth.

What not to do

Do not place aspirin on the gum or against the sore tooth. This is an old piece of folk advice and it causes real harm. Aspirin is an acid, and holding it against soft tissue burns the gum, adding a painful ulcer to your existing toothache. If aspirin is a painkiller you normally take, swallow it as directed instead, and remember it is not suitable for anyone under 16.

Do not hold anything hot against your face. A hot water bottle or heated wheat bag might sound comforting, but if there is an infection brewing, warmth on the outside of the face can encourage swelling and make things worse. Cold is fine. Heat is not.

Do not exceed the doses on the packet, or combine medicines without checking. Many adults can take paracetamol and ibuprofen alongside each other, but only at the stated doses and only if both are suitable for you. A pharmacist can confirm in a minute.

Do not try to burst a swelling, dig at the tooth, or pull it out yourself. This risks driving infection deeper and turning a fixable problem into a bigger one. And do not simply ride it out night after night. Painkillers mask the signal. They do not treat the cause, and dental infections do not heal themselves.

When toothache is urgent

Call a dentist rather than waiting it out if the pain is not controlled by over-the-counter painkillers, if your gum or face is swollen, if you have a fever alongside the toothache, if there is a bad taste or pus in your mouth, if a tooth has been broken or knocked out in an accident, or if the pain has now cost you more than one night of sleep. A toothache that has reached the point of ruining your sleep has usually earned a proper look inside your mouth.

You do not have to wait until morning. Call Day Night Dental at any hour and a member of our reception team will answer, listen to what is happening and help you work out the next step. Our emergency dentist page, linked at the end of this article, explains more about what we see and treat.

When it is more than a toothache: A&E and 999

Most night-time toothache can be managed at home for a few hours and then seen to by a dentist. A small number of situations are different, because a dental infection can occasionally spread and become dangerous. Go straight to A&E, or call 999, if you have any of the following: difficulty breathing or swallowing, swelling that is spreading towards your eye or down your neck, a high temperature together with facial swelling, a serious injury to your face, mouth or jaw, or bleeding that will not stop with firm pressure.

These are not wait-until-morning problems. They need hospital care rather than a dental chair. And if you are unsure where to turn for NHS help out of hours, NHS 24 on 111 is the NHS route in Scotland. They can assess what you describe and direct you to urgent NHS dental care.

You do not have to get through the night alone

We will not pretend a phone call cures a toothache. But there is real relief in speaking to a person who answers at 3am, takes you seriously and tells you plainly what to do next. Our practice in Merchant City, Glasgow is open day and night, every day, and our reception team answers the phone whenever you call. If your tooth is keeping you awake tonight, call us. We will listen, and we will help you sort it.