Toothache at Night? What to Do Until the Dentist Opens

Short answer: a toothache that starts at night can usually be managed until morning with an over-the-counter pain reliever, a warm salt water rinse, a cold compress on the cheek and sleeping with your head raised.¹ Call a dentist as soon as the office opens. If you have swelling that is spreading, a fever, or trouble swallowing or breathing, go to an emergency room tonight.²

Tooth pain has a way of showing up at 11 p.m. on a Friday. It feels worse lying down, it keeps you awake, and it is hard to know whether it can wait. This guide covers what you can safely do at home, which symptoms mean you should not wait, and what happens when you call us for emergency dental care in the morning.

Why does tooth pain get worse at night?

Many people notice that a sore tooth throbs more once they lie down. Lying flat may add pressure around an inflamed tooth, and with fewer distractions you notice the pain more. Clenching or grinding while you sleep can also add force to a tooth that is already cracked or sore. Whatever the reason, pain that keeps you up is a sign the tooth needs to be checked.

What can I do at home to get through the night?

• Take an over-the-counter pain reliever as directed on the label, if it is safe for you. Ibuprofen tends to help dental pain because it also reduces inflammation, and the American Dental Association recommends this type of medicine as the first choice for dental pain.³ If you take blood thinners, have kidney or stomach problems, or are pregnant, check with a pharmacist first.
• Rinse with warm salt water. Half a teaspoon of salt in a glass of warm water, swished gently and spat out, helps clean the area.¹
• Floss around the tooth. A trapped piece of popcorn hull or seed can cause surprisingly sharp pain. Gently floss both sides of the sore tooth.⁴
• Use a cold compress on the outside of your cheek, about 20 minutes at a time. Cold can ease swelling and pain.¹
• Sleep with your head raised on an extra pillow, which many people find more comfortable.
• Avoid very hot, very cold or sugary food and drinks, and chew on the other side.

Two things to skip: do not put aspirin directly on the tooth or gum, because it can burn the tissue.⁴ And if your face is swollen, stick with cold rather than heat, and have a dentist look at the swelling soon.

When is a toothache an emergency that cannot wait until morning?

Many toothaches can safely wait until the office opens. A few signs mean you should get medical care right away, at an emergency room if a dental office is closed:

• Facial swelling that is getting bigger, especially toward the eye, down the neck or under the tongue²⁵
• Difficulty swallowing, breathing, or fully opening your mouth²⁵
• Fever along with tooth pain or swelling²
• Bleeding that does not stop with firm pressure⁴
• An injury to the jaw or face after a fall or accident⁴

A dental infection that spreads into the tissues of the face and neck is serious and needs to be treated quickly.² If you are unsure, it is always better to be checked.

What usually causes a sudden toothache?

The most common causes we see are:

• A deep cavity that has reached the nerve of the tooth⁶
• A cracked tooth, which often hurts when you bite down⁶
• An abscess, an infection in or around the tooth, which may cause a pimple-like bump, a bad taste or swelling²
• A lost filling or crown, which leaves the inner tooth exposed.¹ If that is what happened, our guide to what to do when a crown falls off covers the next steps.
• A wisdom tooth pushing through, with sore or swollen gum around it⁷
• A sinus infection, which can make upper back teeth ache⁸

A quick twinge with cold drinks that fades right away is often an early warning. Sensitivity that lingers after the cold or heat is gone, or pain that throbs on its own, can mean the nerve is more involved and may need treatment.⁶

What happens when I call in the morning?

Call as early as you can. We hold time for urgent cases, and you do not need to be an existing patient. When you arrive, we take a focused x-ray and examine the area, not a full workup. The first goal is to get you out of pain and stable. Then we explain what the permanent fix is, what it costs, and what can be scheduled later.

Depending on the cause, same-day relief might mean a temporary filling, smoothing a broken edge, draining an abscess, starting antibiotics when they are appropriate, or beginning treatment on the nerve. If a tooth cannot be saved, we will talk you through the options for replacing it before anything is removed.

We see emergency patients from across the area, including Leland, Wrightsville Beach and Hampstead. If anxiety about the visit is part of what kept you from calling sooner, sedation is available.

Can a toothache go away on its own?

Sometimes the pain fades, but the cause usually does not. When an infection causes the nerve inside a tooth to die, the pain can stop for a while even as the bacteria keep spreading.² That is why it is worth being seen even if you wake up feeling better.

Tooth pain? Call Atlantic Dental Group

If you have a toothache, call 910-762-0958 first thing and we will find you the first available time. You can also request an appointment online, and we will get back to you.

Sources

1. Cleveland Clinic. Toothache: Symptoms, Causes & Remedies. Cleveland Clinic.
2. Cleveland Clinic. Tooth Abscess: Symptoms, Causes & Treatment. Cleveland Clinic.
3. American Dental Association. Oral Analgesics for Acute Dental Pain. ada.org.
4. American Dental Association. Dental Emergencies. MouthHealthy.org.
5. National Library of Medicine. Ludwig angina. MedlinePlus Medical Encyclopedia.
6. American Association of Endodontists. What is a Root Canal?. aae.org.
7. National Library of Medicine. Impacted tooth. MedlinePlus Medical Encyclopedia.
8. National Library of Medicine. Toothaches. MedlinePlus Medical Encyclopedia.

This article is general information for patients. It is not a diagnosis, and it does not replace an exam or advice from your own dentist or physician.