Toothache worse at night? Why it happens and what helps

What’s probably going on

Night doesn’t cause a toothache. It turns up the volume on one that’s already there, and several things stack up once you go to bed.

• Lying down. The nerves and blood vessels in the middle of your tooth, called the pulp, sit inside a hard shell that can’t stretch. When the pulp is inflamed, pressure builds with nowhere to go. Root canal specialists note this kind of pain can get worse when you lie down or bend over.
• Nothing else to notice. A dark, quiet room leaves the pain as the only thing to focus on, so it can feel louder. Pain and poor sleep also feed each other: pain breaks up sleep, and bad sleep makes pain feel worse.
• Grinding or clenching in your sleep. A dull, steady ache can be a sign you grind your teeth at night. Grinding can also wear down enamel and irritate the nerve over time. See grinding.

The pulp usually gets inflamed because of a deep cavity, a crack, worn enamel, or recent dental work. Dentists sort that inflammation into two kinds, and the difference tells you how soon to go.

• Reversible (the nerve can recover). A sharp zing from cold or sweets that fades within a few seconds. Once a dentist removes the cause, often with a filling, the tooth can settle down.
• Irreversible (the nerve can’t recover). Pain from heat, cold or sweets that lingers, often 30 seconds or more. It may also start on its own, throb, be hard to pin to one tooth, and barely respond to over-the-counter pain relievers.

If your night pain fits the second pattern, see a dentist soon. If there’s also swelling, a bump on the gum or a bad taste, read about tooth abscess.

Pain that suddenly stops after nights of throbbing isn’t necessarily good news. The nerve may have died, and the tooth still needs a dentist.

What to do tonight

Start with the basics in what to do for a toothache right now: rinse, floss gently, a cold pack, and a pain reliever. A few things matter more at bedtime.

1. Prop your head up. Sleep on an extra pillow rather than lying flat. Since lying down can make this kind of pain worse, a little height may help.
2. Put a cold pack on your cheek before bed. Wrap it in a thin towel and hold it over the sore side. Cold helps shrink blood vessels, which can ease pain and swelling. Never use heat on a swollen face.
3. Take an over-the-counter pain reliever as the label directs. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney or bleeding problems.
4. Skip the triggers. Avoid very hot, cold or sweet food and drinks before bed, and chew on the other side.
5. Call in the morning. Book the first appointment you can get, even if the pain has eased by then.

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, even at 3 a.m. Call a dentist’s after-hours line instead.
• Don’t cancel because it feels better by morning. Whatever inflamed the nerve is still in the tooth.

How a dentist fixes it, and what it costs

A dentist checks how the tooth reacts to cold and to gentle tapping. That helps show which kind of inflammation it is, and what the tooth needs.

• Reversible inflammation usually means removing the decay or other cause and sealing the tooth with a filling.
• Irreversible inflammation needs a root canal, which removes the inflamed pulp, usually followed by a crown. The other option is taking the tooth out.
• Grinding is usually managed with a night guard, plus fixing any damage it has caused.

Catching the problem while the nerve can still recover usually means a simpler fix. The price depends on the treatment, the tooth, where you live and your coverage, so ask for a written estimate before any work starts.

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

Night-time toothaches usually start as something small that nobody caught.

• Brush twice a day and floss once a day.
• Get routine checkups and cleanings, so cavities are filled while they’re small.
• Tell your dentist about any new sensitivity to hot, cold or sweets. See tooth sensitive to cold.
• If you grind your teeth at night, ask about a night guard.

A good electric toothbrush makes the first habit easier. See the best electric toothbrush.