Toothache never comes at the “right time”, yet nighttime often seems to be when it becomes unbearable. Many patients ask the same question: “Why does my tooth hurt the most when I lie down?”
A toothache at night is not just unpleasant – it can be a sign of a serious dental problem that requires professional intervention. In this article, we explore why teeth hurt more at night, what you can do at home to ease the pain, and when it’s time to seek emergency dental help.
Why does tooth pain feel worse at night?
There are several reasons why tooth pain tends to intensify at night. While the cause may vary depending on the dental condition, some mechanisms are quite common:
1. The horizontal position increases pressure
When lying down, blood tends to accumulate more easily in the head area, including the inflamed tissues surrounding the tooth. The increased blood flow irritates the nerve endings and amplifies the sensation of pain.
During the day, gravity helps maintain balanced circulation, but at night, the pressure in the jaw area can rise, making the pain feel more intense.
2. Lack of distractions
Throughout the day, thoughts are focused on work, conversations, and activities. At night, when the body is at rest, there are fewer distractions. The brain becomes more aware of discomfort, making pain feel stronger.
3. Reduced saliva production
During sleep, the production of saliva naturally decreases. Saliva plays a crucial role in neutralising bacteria and maintaining balance in the mouth. When its production drops, bacteria multiply more easily, worsening inflammation and pain.
4. Existing infections and inflammation
Chronic inflammations, granulomas, or untreated cavities can exist for a long time without symptoms. However, when bacteria reach the dental pulp or the area around the root tip, pain can appear suddenly – often at night when the body is relaxed and the pain threshold is lower.
The most common causes of nighttime toothache
Understanding the possible causes of nighttime tooth pain is key to responding appropriately. In most cases, the intensity of pain during the night points to an existing dental problem that may have been symptom-free for some time.
Here are the most common causes:
1. Deep tooth decay (Caries)
Untreated cavities can progress to the pulp – the soft inner tissue containing nerves and blood vessels. When bacteria reach this sensitive area, a strong, throbbing pain occurs, often worse at night.
2. Pulpitis (inflammation of the dental pulp)
Pulpitis can be reversible (temporary) or irreversible (permanent). In its later stage, the pain becomes intense, particularly when exposed to heat or during the night. In such cases, root canal treatment is usually required.
3. Dental abscess (Pus pocket)
An abscess near the tooth root (periapical abscess) causes pressure, swelling, and severe pain that worsens when lying down.
This is a serious condition that requires immediate dental intervention.
4. Gum inflammation or periodontitis
Sometimes, tooth pain is not caused by the tooth itself but by inflammation of the supporting tissues. Periodontitis can cause tenderness and discomfort, more noticeable at night – especially when pus or gum recession is present.
5. Cracked filling or damaged tooth
If a tooth is cracked or a filling has fallen out, the dentine and nerve may be exposed to external stimuli. This can trigger sudden sensitivity and pain at night, particularly to cold or pressure.
6. Bruxism (Teeth grinding)
Night-time clenching and grinding of teeth, often unconsciously, can lead to pain in the teeth and jaw. The pain is usually dull but may become acute if the teeth are weakened or there is an existing inflammation.
What can you do at home while waiting for your dental appointment?
It’s important to note that no home remedy can permanently eliminate the cause of a toothache. However, if pain occurs during the night or at the weekend, there are steps you can take to reduce discomfort until you see your dentist.
Here’s what you can do:
1. Oral painkillers (Analgesics)
Medicines such as ibuprofen or paracetamol can help ease pain.
Ibuprofen also has anti-inflammatory effects, which can reduce swelling and pressure.
Important: Always follow the recommended dosage and never apply medication directly to the tooth or gums.
2. Rinse with warm salt water
One of the oldest and safest temporary methods to relieve inflammation. Mix half a teaspoon of salt in a glass of warm water and rinse your mouth for 30 seconds – do not swallow.
This method can help reduce bacteria and irritation.
3. Avoid hot, cold, and sugary foods
Foods and drinks that are very hot, cold, or sweet can worsen symptoms. Try chewing on the opposite side and choose neutral, soft foods.
4. Keep your head elevated while sleeping
Use an extra pillow under your head. This helps reduce blood pressure in the jaw area and may ease pain.
5. Apply a cold compress (Externally)
If swelling is present, apply a cold compress on the cheek (wrapped in a cloth, not directly on the skin).
It can help reduce both swelling and pain.
Important: Never apply ice directly to the tooth – it can increase sensitivity.
6. Avoid smoking and alcohol
These substances can further irritate dental tissues and slow down the healing process.
7. Gentle brushing and flossing
Sometimes, pain is caused by food particles stuck between teeth. Gently cleaning can remove irritation – but be careful not to worsen the condition if the tooth is already inflamed.
When is a toothache an emergency, and when should you visit an emergency dentist?
Although many toothaches can wait until a regular appointment, there are situations where delaying treatment can be risky and lead to serious health consequences.
Here’s how to recognise when a toothache becomes urgent:
1. Persistent, intense pain that worsens
If the pain wakes you up at night, doesn’t subside after taking painkillers, or increases over time, it may indicate nerve inflammation or a dental abscess that requires immediate evaluation.
2. Swelling of the face, jaw, or gums
Swelling around a tooth – especially if spreading towards the eye, neck, or ear – may signal an infection that could endanger surrounding areas. This is an emergency condition that may require antibiotics, drainage, or even hospitalisation.
3. Fever and general malaise
If a toothache is accompanied by fever, chills, fatigue, and weakness, it may indicate a systemic infection. This condition requires urgent medical attention.
4. Presence of pus or a bad taste in the mouth
If pus or a draining fistula appears, it’s likely an abscess. Although this might temporarily reduce pressure and pain, the infection persists and must be treated professionally.
5. Loose teeth, bite changes, or difficulty opening the mouth
These symptoms can indicate advanced periodontitis, tooth fractures, jaw dislocation, or other severe complications.
When to seek emergency dental care
• Pain that won’t subside and disrupts your sleep
• Swelling of the face or neck
• Fever accompanied by tooth pain
• Difficulty breathing or swallowing
• Bad taste and pus discharge in the mouth
In all these cases, do not wait – contact an emergency dentist or visit the on-call dental service.
Why does a toothache get worse at night?
Many patients notice that their toothache becomes significantly more painful at night, especially when lying down. Although pain may also be present during the day, it becomes more noticeable in quiet, resting conditions.
The reasons are mainly physiological:
1. Body position when lying down
When we lie flat, blood flow to the head and jaw area increases. This increased circulation can raise pressure on the inflamed tissues around the tooth, leading to stronger pain.
That’s why many patients prefer sleeping in a semi-upright position when struggling with a toothache.
2. Fewer external stimuli
During the day, conversations, work, and background noise distract our attention. At night, when everything is quiet, the brain focuses entirely on discomfort, making pain feel stronger.
3. Night-time nervous system activity
At night, the parasympathetic nervous system activates, promoting recovery but also potentially intensifying inflammatory responses. In cases of infection or inflammation, this can heighten pain sensations.
4. Bruxism (Teeth grinding)
Some people unconsciously clench or grind their teeth while sleeping. This can irritate sensitive teeth further, aggravate inflammation, and cause discomfort.
5. Lack of distraction and increased anxiety
Worrying about pain, combined with fatigue and stress, can heighten the perception of discomfort. The psychological aspect of pain should not be underestimated – anxiety increases pain sensitivity.
Common causes of night-time toothache and how to recognise them
Night-time toothache is not always caused by the same issue. Depending on the nature, location, and accompanying symptoms, you can get an idea of what might be happening.
Below are the most common causes and their typical characteristics:
1. Deep decay (Pulpitis)
• Pain: Sharp, throbbing, worsens with heat or sweetness.
• Especially intense at night due to pressure in the pulp chamber.
• Persistent sensitivity after stimuli (e.g. hot drinks).
• May indicate the need for root canal treatment.
2. Dental abscess (Infection)
• Pain: Severe, constant, often with swelling and tenderness.
• Pus discharge, unpleasant taste, and fever may occur.
• Requires urgent dental examination and likely antibiotic therapy.
3. Wisdom tooth eruption
• Pain: Dull, pressing in the back of the jaw, difficulty opening the mouth.
• Often accompanied by gum swelling or discomfort while chewing.
• May be associated with a mild fever.
4. Tooth sensitivity (Dentine hypersensitivity)
• Pain: Short, sharp pain triggered by cold, sweet, or acidic food.
• Does not last long and doesn’t occur spontaneously.
• Causes: Worn enamel, gum recession, or microcracks in teeth.
5. Bruxism (Teeth grinding)
• Pain: Dull ache in the jaw, teeth, or temples, particularly in the morning.
• Often linked with jaw muscle pain and headaches.
• Teeth may appear flattened and enamel worn down.
6. Periodontitis (Advanced gum disease)
• Pain: Mild to moderate, with bleeding and gum recession.
• Possible loose teeth and bad breath.
• Night pain occurs in advanced stages or secondary infections.
Can nighttime toothache be related to other health conditions?
While a toothache is usually caused by dental issues, it can sometimes stem from other medical problems.
Certain conditions can cause pain that radiates to the jaw and face, becoming worse at night.
1. Sinusitis (Sinus infection)
Inflamed sinuses can create pressure on the upper back teeth, as their roots are located close to the sinus cavity.
• Pain affects several teeth at once, especially when bending forward.
• Usually accompanied by a blocked nose, headache, and pressure around the eyes.
2. Temporomandibular joint disorders (TMJ)
TMJ dysfunction can cause jaw pain that radiates to the teeth.
• Pain in chewing muscles, clicking jaw joint, limited mouth opening.
• Pain often worsens at night due to head position or teeth grinding.
3. Trigeminal neuralgia
A rare but extremely painful condition.
• Pain is sudden, intense, electric-shock-like, usually on one side of the face.
• Can easily be mistaken for a toothache.
• Diagnosis is made by a neurologist.
4. Stress and anxiety
Psychological factors can amplify pain perception.
• Increased muscle tension in the jaw, more frequent grinding or clenching.
• People under stress often ignore early signs of dental issues, leading to worsening conditions.
Because of all these possibilities, it’s crucial not to make assumptions based on symptoms alone. Even if your discomfort feels typical, only a dentist can make a definitive diagnosis.
How to relieve a toothache at home until you see a dentist
A toothache that strikes at night can be distressing – pharmacies are closed, dental clinics are unavailable, and pain may be strong enough to prevent sleep.
In such cases, certain home measures can temporarily reduce symptoms until you see a professional.
These methods are not a substitute for a dental visit, but they can provide short-term relief.
1. Over-the-counter painkillers
Pain relievers like ibuprofen or paracetamol can help ease tooth pain.
• Ibuprofen also provides anti-inflammatory effects, helpful for inflamed nerves or swollen tissues.
• Never exceed the recommended daily dose.
Important: Avoid placing tablets directly on the tooth or gum – this can cause chemical burns.
2. Cold compress on the cheek
Applying a cold compress externally (on the cheek above the painful area) can reduce inflammation and pain.
• Keep the compress on for 10–15 minutes, then take a break.
• Do not apply ice directly to the skin – wrap it in a cloth or towel.
3. Rinse with salt water
A warm (not hot) salt solution can help reduce inflammation and disinfect the mouth.
• Use 1 teaspoon of salt in a glass of warm water.
• Rinse for 30 seconds several times a day, including before bedtime.
4. Avoid lying completely flat
Lying flat increases pressure in the head and can worsen the pain.
• Keep your head elevated with an extra pillow to relieve throbbing pain.
5. Avoid foods and drinks that trigger symptoms
• Hot, cold, sweet, or acidic foods can irritate the nerve further.
• Chew on the opposite side of the mouth if possible.
6. Herbal remedies – use with caution
Some people try natural remedies such as garlic, cloves, or essential oils. While these may have mild soothing effects:
They should not be used without professional advice, as they can cause irritation or allergic reactions.
When does a toothache require emergency dental treatment?
Most toothaches can wait until the next morning, but some cases require immediate dental attention.
Recognising these symptoms can prevent severe complications, such as infection spreading to nearby tissues or even the whole body.
1. Severe, persistent pain unresponsive to painkillers
If pain relief doesn’t work, it could indicate an acute infection needing emergency treatment – such as tooth drainage, abscess removal, or antibiotic therapy.
2. Facial or jaw swelling
Noticeable swelling, especially if accompanied by redness, tight skin, and fever, can indicate a serious infection like a dental abscess.
In severe cases, infection can spread to the neck’s soft tissues, which can be life-threatening.
3. Difficulty opening the mouth or swallowing
If you struggle to open your mouth, swallow, or feel a lump in your throat, the infection might have spread deeper.
Contact an emergency dentist or, in severe cases, go directly to the hospital.
4. High temperature and general fatigue
Fever, chills, rapid heartbeat, and exhaustion may indicate systemic infection. Combined with a toothache, these symptoms require urgent care.
5. Pus discharge (Fistula)
A small bump or “pimple” on the gum that releases pus signals an abscess with a draining fistula.
Even if pain decreases temporarily, the infection remains and needs dental treatment.
In all these situations, do not delay or rely on home remedies – postponement can lead to complications, tooth loss, or systemic infection.
How to prevent nighttime toothache and avoid emergencies
While it’s sometimes impossible to completely prevent toothache, especially with deep cavities or past trauma, many cases can be avoided through good oral hygiene and regular dental check-ups.
Prevention remains the most effective “treatment” for long-term oral health and peaceful nights without pain.
1. Regular brushing and flossing
The simplest step in preventing gum disease and cavities is daily hygiene:
• Brush teeth thoroughly twice a day using fluoride toothpaste.
• Use dental floss or interdental brushes once daily.
• Clean your tongue to reduce bacteria that cause bad breath and inflammation.
2. Professional cleaning and routine examinations
• Visit your dentist every six months, even if you feel fine.
• Routine check-ups can detect early cavities and prevent infections.
• Professional cleaning (scaling, air polishing, and polishing) lowers the risk of gum inflammation and periodontitis.
3. Timely treatment
• Many patients postpone visits until pain appears.
• Pain often indicates that the condition has advanced – early treatment saves time and cost.
• Treating cavities, damaged fillings, or cracked teeth early can prevent the need for root canal treatment or extraction.
4. Recognising symptoms early
• Don’t ignore pain when chewing or sensitivity to hot/cold drinks.
• Any discomfort, tooth colour change, or spontaneous pain requires professional evaluation.
5. Protecting teeth from grinding (Bruxism)
Night-time clenching or grinding can cause sensitivity, pain, and wear.
• The solution is a custom-made night guard prepared by a dentist.
• Regular monitoring is especially important for patients with bruxism.
Peaceful nights begin with healthy teeth
Night-time toothache can seriously affect your quality of life – but it’s also an important warning sign.
The most common causes – deep decay, nerve infection, gum disease, or bruxism – usually result from undetected or untreated problems.
Rather than relying on temporary home fixes, the key step is visiting a dentist who can identify the cause and provide proper treatment.
At Esthea Polyclinic, every patient receives personalised care – from precise diagnostics to an individual treatment plan.
If you’re struggling with pain that worsens at night or have already experienced unpleasant nocturnal episodes, our dental team is here to offer expert advice, examination, and timely therapy.
Take care of your teeth during the day, so they can let you rest at night.