Why Is Toothache Worse at Night? The Real Reason and How to Get Relief

Toothache genuinely does get worse at night, and no, you’re not being dramatic about it. The main reason is that when you lie down, more blood flows to your head, and that extra blood puts more pressure on an already irritated tooth. 

On top of that, all the things that kept you distracted during the day, like work, conversation, eating, moving around, are gone. It’s quiet. There’s nothing between you and the tooth anymore. 

So that toothache becomes the only thing you can focus on at night. But how to get relief from this toothache? In this guide, we’ll look at all the reasons toothache gets worse at night and also the different methods you can try to get relief.

The Real Reasons Toothache Gets Worse at Night

Toothache gets worse at night not because of one single reason but from a combination of a few:

Blood flow changes when you lie down

When you’re upright during the day, gravity keeps draining blood away from your head. When you lie flat at night, blood pools in the head and neck and the pressure around your teeth increases. 

If a tooth is already inflamed, that extra pressure pushes directly on the nerve. The throbbing you feel is your heartbeat pulsing through the inflamed tissue.

There’s nothing to distract you 

During the day, your brain has a hundred things competing for its attention. 

At night, in a quiet room, the only signal getting through is the pain. The toothache hasn’t actually changed. Your awareness of it has.

You might be grinding your teeth 

A lot of people clench or grind their teeth at night without knowing it. If a tooth is already cracked, decayed, or sensitive, the pressure from grinding makes it significantly worse. You wake up with jaw pain on top of the toothache, and the two feed into each other.

Sinus pressure can add to it 

The roots of your upper back teeth sit very close to your sinuses. If you’ve got any congestion, a cold, allergies, or a sinus infection, lying down increases the sinus pressure 

This pushes the sinus down onto those tooth roots. The pain feels like a toothache but it’s actually coming from above.

Late-night eating doesn’t help 

If you’ve eaten something sugary or acidic before bed and haven’t brushed afterward, that food is sitting against a tooth that might already be compromised. 

The bacteria feed on it which makes the acidity irritate the nerve, and the pain ramps up right as you’re trying to fall asleep.

What’s Actually Causing the Toothache in the First Place

The nighttime part is about why the pain gets worse. But the pain itself has a cause, and that’s what needs to be treated if you need relief.

Toothache that wakes you up or keeps you awake almost always points to one of a few things.

• A cavity that’s reached the nerve: When decay gets deep enough to reach the inner part of the tooth, the nerve becomes inflamed. That inflammation produces a throbbing, constant pain that gets worse with pressure changes, which is exactly what happens when you lie down.
• An infection or abscess: If bacteria have reached the root of the tooth, an abscess can form. The pressure from the trapped infection builds up, and lying flat makes it worse. Abscesses don’t go away on their own. They need treatment.
• A cracked tooth: Cracks can be invisible to the eye but deep enough to irritate the nerve. The pain comes and goes during the day but becomes constant at night when the pressure changes.
• Gum disease: Advanced gum disease can cause a deep, aching pain around the affected teeth. Lying down increases blood flow to the inflamed gum tissue and the pain becomes more noticeable.
• A failing filling or crown: Old dental work can deteriorate over time, letting bacteria in underneath. The tooth looks fine from the outside but the nerve underneath is under pressure.

How to Get Relief Tonight

If you’re in pain right now and can’t see a dentist until the morning, here’s what you can do to get some temporary relief.

Prop your head up

Add an extra pillow or two. Keeping your head elevated above your heart reduces blood flow to the area and takes some of the pressure off the tooth. This is the single most effective thing you can do right now.

Take the right painkillers 

Ibuprofen is the best option for toothache because it reduces inflammation, not just pain. Take 400mg with food. If that’s not enough on its own, you can add paracetamol on top. The two work differently and can be taken together safely. Don’t exceed the recommended dose on either, though.

Rinse with warm salt water 

Take half a teaspoon of salt in a cup of warm water. Swish it gently around the sore side and let it fall out. It won’t fix the problem, but it reduces bacteria and soothes inflamed tissue. You can repeat it every couple of hours.

Use a cold compress on the outside 

Take a bag of frozen peas (or anything cold) wrapped in a tea towel and hold it against the cheek on the sore side for 15 to 20 minutes. The cold numbs the nerve endings and reduces swelling. Take it off for 20 minutes before reapplying.

Avoid hot or cold drinks 

If the tooth is sensitive, temperature extremes will make it flare. Stick to room temperature water until you can get it looked at.

Don’t lie on the sore side 

Sleep on the opposite side or on your back with your head raised. Lying directly on the painful side increases the pressure even more.

Toothache getting worse? Call us on 020 7580 4200.

When a Nighttime Toothache Needs Urgent Attention

If the toothache is mild or isn’t accompanied by other symptoms, it can usually wait till the next available appointment. But if it is unbearable or you have other symptoms, it’s best to seek proper medical care immediately.

Call a dentist or seek urgent care if:

• The pain is severe and painkillers aren’t helping it
• There’s visible swelling in the face, jaw, or neck
• You’ve got a fever alongside the toothache
• You’re having difficulty swallowing or opening your mouth
• The pain started after a trauma or injury to the face

Swelling that spreads to the neck or under the eye, difficulty breathing, or a fever over 38°C with dental pain are signs of a spreading infection and need same-day attention.

How to Stop Toothache Coming Back at Night

The relief measures above are temporary. But if you want the pain to stop coming back, you need to address the main cause and any habits contributing to the pain.

If you’re grinding your teeth, a night guard protects them from the pressure. A dentist can have one made to fit your mouth, and for a lot of people it’s the thing that finally breaks the cycle of waking up in pain.

If the cause is decay, a crack, or an infection, the tooth needs treating. A filling, a root canal, a crown, or in some cases an extraction can help. 

If it’s a sinus issue rather than a dental one, the pain will usually affect several upper teeth at once rather than one specific tooth, and it’ll come with congestion or face pressure. That’s worth mentioning when you see the dentist, because it changes the treatment entirely.

And if you’ve been ignoring a mild toothache during the day hoping it’ll go away, it probably won’t. Toothaches tend to get worse over time. So, it’s worth addressing the problem when it is small rather than waiting for the pain to become unbearable.

Where That Leaves You

Toothache does get worse at night due to blood flow and gravity working against you. You can try any of our above mentioned methods to get temporary relief from the pain.

But even if you feel the toothache has improved the next morning, it’s worth getting checked out at the dentist, before it turns into something more.

At Specialist Dental Services, our team includes endodontists and oral surgeons who deal with exactly this kind of pain every day. A consultation at SDS starts from £325, and we can usually see you quickly and diagnose the problem at the earliest.

Call us at 020 7580 4200 

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