Toothache at Night: Why It Gets Worse and What to Do

Why does a toothache seem worse at night?

The sources we reviewed do not give one simple reason, so we will not guess. What they do show is useful. The American Association of Endodontists says tooth pain, whether sharp and throbbing or dull and achy, can make it hard to concentrate, get through the day, and even sleep at night.

A second clue is grinding. The American Dental Association (ADA) says most people who grind their teeth do it while they sleep, and most are not aware of it. The American Association of Endodontists says grinding can cause a dull ache and pressure in the upper teeth and jaw. Either way, pain that keeps you up is a signal to see a dentist.

What can cause tooth pain?

Many things can. MedlinePlus says a toothache is often the result of cavities, or an infection or irritation of the tooth. Cleveland Clinic lists cavities, an abscessed tooth, a cracked tooth, a damaged filling or crown, teeth grinding or clenching, and gum disease. Your dentist finds the cause with an exam and often an X-ray.

Not every toothache starts in the tooth. MedlinePlus says pain felt in a tooth can actually come from other parts of the body, such as a sinus infection. It also lists a heart attack, which can include jaw pain, neck pain or toothache. If you think your pain could be your heart, call 911.

What does my symptom suggest?

This table shows what the American Association of Endodontists says about common patterns. It is a guide for questions to ask, not a diagnosis.

For more on the inner part of a tooth, see tooth pulp. For brief sharp reactions, see tooth sensitivity.

What can I do tonight?

You can take comfort steps while you wait for a dentist. None of them treat the cause.

1. Rinse and floss. The ADA says to rinse with warm water and gently floss to remove food caught between the teeth.
2. Use a pain reliever. Cleveland Clinic says you can take over-the-counter pain relievers such as acetaminophen or ibuprofen while you wait. Follow the label.
3. Try a saltwater rinse. Cleveland Clinic suggests mixing 1/2 teaspoon of salt into 8 ounces of warm water and swishing for 30 seconds.
4. Use a cold pack. Wrap ice in a clean towel and hold it against the outside of the jaw for about 20 minutes.
5. Do not put aspirin on the tooth. The ADA says not to put aspirin on the aching tooth or gum tissues.

Cleveland Clinic warns that antibiotics and pain relievers can ease symptoms, but only for a time. If the cause is not treated, the pain will return.

When is a toothache an emergency?

Go to an emergency room for the signs Cleveland Clinic lists:

• Swelling below your eye or a knot on your jaw
• Unbearable tooth pain that does not get better with medication
• Bleeding that will not stop with pressure
• A fever over 101 degrees Fahrenheit (38.33 degrees Celsius)

Cleveland Clinic also says unbearable tooth pain with fever and chills is a dental emergency. Call 911 or go to the nearest emergency room if you have difficulty breathing or swallowing. Read swollen face and tooth abscess and emergency dentist, urgent care or ER for more.

When should I call the dentist?

Call soon, even if the pain eases. Cleveland Clinic says to call a dentist right away if a toothache lasts longer than two days or comes with swelling in the face or jaw. MedlinePlus says to seek care for a severe toothache or one that lasts longer than a day or two.

Town Center Dental is open Monday to Wednesday from 8am to 5pm and Thursday from 8am to 4pm. It is closed Friday to Sunday. If your pain starts at night or on a weekend and you have no danger signs, use the comfort steps above and call (636) 273-5866 when the office opens. If you have a danger sign, do not wait.

What will the dentist do about a toothache?

The dentist first finds the cause. Cleveland Clinic says a dentist will examine you and ask about your symptoms, and may take a dental X-ray to look for problems beneath the gums. Treatment depends on what is found. A larger cavity or fracture may need a crown. If bacteria from a cavity or crack reach the pulp, Cleveland Clinic says you will need a root canal. It adds that most dentists prefer to save natural teeth when they can, but sometimes that is not possible.

A toothache is a symptom, not a diagnosis. Your dentist will explain what they find and what to expect before any treatment begins.

What if I grind my teeth?

Tell your dentist about any bruxism. If your dentist sees worn or chipped teeth, they may suggest a night guard. Read our guide to toothache causes and relief for more.

What will the dentist ask about my toothache?

MedlinePlus lists the questions a dentist is likely to ask. They include when the pain started, where it is and how bad it is, whether the pain wakes you up at night, what makes it better or worse, what medicines you take, whether you have a fever or other symptoms, whether you have had any injuries, and when you last had a dental checkup.

You can prepare by writing short answers before the visit. Pain that wakes you at night is useful information, so say so plainly. A clear history helps your dentist find the cause faster.

Next step

Do not let a toothache run for days. Read about emergency dentistry at Town Center Dental, then call (636) 273-5866 during office hours or request an appointment.