How to sleep with a toothache: what actually helps

What’s probably going on

A toothache usually means the nerve inside a tooth is irritated, or there’s an infection at the root or in the gum. Lying down in a dark, quiet room tends to make it feel louder. The why is covered in toothache worse at night; this page is about getting through the night.

The pain pattern tells you how long you can wait.

• A zing from cold or sweets that fades in seconds can usually wait for a normal appointment.
• Throbbing that starts on its own, or lingers after hot or cold, often means the nerve is badly inflamed. Call a dentist in the morning. See throbbing tooth pain.
• Pain with swelling, a bump on the gum or a bad taste can mean an infection. See tooth abscess.

What to do tonight

Start about an hour before bed, so the pain reliever is working when you lie down.

1. Take an over-the-counter pain reliever as the label directs. For adults and teens 12 and up, the American Dental Association’s guideline puts anti-inflammatories such as ibuprofen or naproxen first, alone or combined with acetaminophen. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney or bleeding problems.
2. Eat early, and eat soft. Finish dinner well before bed and chew on the other side. Skip very hot, very cold and sweet food and drinks, which can set off an irritated tooth.
3. Clean the area gently. Rinse with warm water, or warm salt water (about half a teaspoon in a cup), then spit. Floss gently around the tooth; a trapped seed or popcorn hull can ache like a bad tooth.
4. Hold a cold pack on your cheek. Wrap it in a thin towel and hold it over the sore side for about 20 minutes. You can repeat it through the evening. Never use heat on a swollen face.
5. Prop your head up. Sleep on an extra pillow or two instead of lying flat. Lying down can make an inflamed tooth throb more, so a little height may help.
6. Try a numbing gel if you need it. A little benzocaine gel on a cotton swab can numb the gum around the tooth. Use it only as the label directs, and never on children under 2. It’s a bridge to sleep, not a fix, and it isn’t meant for long-term use.
7. Keep a glass of water by the bed. If the pain wakes you, rinse and check the label before taking another dose. Don’t take the next dose early.
8. Lower the volume elsewhere. A podcast, white noise or an audiobook gives your mind something besides the tooth to focus on.

If a filling has fallen out, cover the hole with a temporary filling from the pharmacy. See lost a filling.

What not to do

• Don’t put aspirin on the tooth or gum. It burns the tissue and doesn’t help the tooth.
• Don’t take more pain reliever than the label allows, or stack two products with the same ingredient. Cold and flu medicines often contain acetaminophen too.
• Don’t use a heating pad on your face. Heat can make swelling worse.
• Don’t take leftover antibiotics. They don’t fix the tooth, and only a dentist or doctor should decide if you need them.
• Don’t cancel the appointment because you slept. Relief isn’t a cure; the cause is still there.

When not to wait until morning

Most toothaches can wait for a dentist’s office to open. Some can’t. Go to an emergency room tonight if you have:

• Swelling in your face, below your eye or in your neck
• Trouble swallowing, breathing or speaking
• A fever along with tooth pain or swelling
• Pain so bad that pain relievers don’t touch it

These can be signs that an infection is spreading, which needs care the same night.

If none of those apply but you’re unsure, many dental offices have an after-hours line. It’s worth a call before you settle in for a bad night. A virtual dentist visit is another option for advice at odd hours.

How a dentist fixes it, and what it costs

Tonight’s steps only calm the pain. A dentist finds the cause, usually with an exam and an X-ray.

• A cavity usually gets a filling.
• An inflamed or infected nerve usually needs a root canal and often a crown, or the tooth is taken out.
• A crack often needs a crown.
• Grinding is usually managed with a night guard.

The price depends on the treatment, the tooth, where you live and your coverage, so ask for a written estimate before any work starts. The root canal cost and tooth extraction cost guides walk through the numbers. If you don’t have dental insurance, a dental savings plan (a discount membership, not insurance) can cut the price at participating dentists.

How to keep it from coming back

A night like this usually starts months earlier, as a small cavity or crack nobody caught.

• Brush twice a day with a fluoride toothpaste, and clean between your teeth once a day.
• Cut back on sipping sugary or acidic drinks through the day.
• Get regular checkups, so small problems are fixed before they wake you up.
• Mention any new sensitivity to hot, cold or sweets at your next visit.
• If you wake with a sore jaw, ask about a night guard. See grinding.

Keeping a few basics in one place makes the next bad night easier. See dental emergency kit.