How Do I Stop a Toothache at Night?
Take your usual painkiller at the correct dose and at the right interval, prop your head up on an extra pillow, and keep hot, cold and sweet things away from that side. A cold pack against the cheek helps for fifteen minutes at a time. None of it treats the cause — a toothache that wakes you usually means the nerve is inflamed or dying, and that does not settle by itself.
Why it is worse at night
Two things change when you lie down. Blood pressure inside the head rises slightly, and an inflamed pulp sits in a rigid chamber with nowhere to swell — so the pressure it is already under goes up. That is why a tooth that merely niggled during the day can throb once you are flat.
The other half is simply that there is nothing else to attend to. Pain that was competing with work and daylight has the room to itself at two in the morning. Both are real; neither means the tooth has suddenly got worse in the last hour.
What actually helps until morning
Take the painkiller properly. Most people under-dose, take it too late, or stop as soon as it eases. Take your usual one at the full dose on the packet, on time rather than when the pain returns. If you normally take two kinds, ask a pharmacist how to space them rather than doubling up.
Raise your head. An extra pillow, or sleeping propped rather than flat, takes some of the pressure off. It is the simplest thing on this list and it is usually the one people have not tried.
Cold on the outside, not the inside. A cold pack against the cheek for fifteen minutes at a time helps. Holding ice water in the mouth often makes a dying nerve worse, and heat almost always does.
Leave that side alone. Nothing hot, cold, sweet or hard on the painful side, and do not chew on it to test whether it still hurts. Keep it clean gently; an irritated gum around a tooth sometimes settles a good deal with careful brushing.
Do not put aspirin against the gum. It does not work that way and it burns the tissue it is resting on.
What the pain is telling you
A short, sharp zing with cold that stops as soon as the cold does is usually sensitivity or a small area of decay, and is not an emergency.
A deep ache that lingers after the stimulus has gone, that is worse lying down, or that wakes you, points to the pulp being inflamed or dying. That is the pattern that ends in root canal treatment or extraction, and waiting rarely improves the options.
Pain on biting that is sharp and specific can be a crack. Pain with a bad taste, a swelling, or a tooth that feels high when you close suggests infection that has reached beyond the root tip.
When it is not a wait-until-morning problem
Facial swelling, especially if it is spreading towards the eye or under the jaw, difficulty swallowing or breathing, or a fever alongside dental pain are hospital problems rather than dental ones. Go to an emergency department rather than waiting for a clinic to open.
Short of that, call us when we open on 6443 9509 and say it kept you awake, because that sentence tells us what kind of pain it is. What we hold in the diary for patients in pain is set out on the emergency page.
Questions
Will painkillers be enough to get me through?
Usually, for a night. They manage the symptom rather than the cause, and a pulp that is dying will keep producing pain until it is treated. If you are needing painkillers around the clock to stay comfortable, that is the tooth telling you it needs seeing rather than medicating.
Should I use clove oil?
It can numb the area briefly and plenty of people find it takes the edge off. It also irritates gum and tongue if it is used repeatedly or neat, and it does nothing for an inflamed nerve inside the tooth. Treat it as a short-term comfort, not a treatment.
Is it bad that the pain stopped on its own?
Not necessarily good news. A pulp that dies stops hurting, sometimes for weeks, and the problem then moves quietly to the bone around the root tip. Pain that disappears without anything being done is still worth having looked at.
Can I just take antibiotics?
Antibiotics do not reach the inside of a tooth, because there is no blood supply left to carry them there. They have a place where infection has spread into the surrounding tissue, alongside treatment, but they are not an alternative to dealing with the tooth.