Patient guide

Toothache at night: why it happens and what to do

Toothache that keeps you awake is common, and it is almost always telling you something that will not fix itself. Here is what usually causes it, what helps until you can be seen, and when it cannot wait until morning.

General information from Carmel Dental Clinic, last reviewed 17 September 2026. Not a diagnosis.

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Waiting bench beside the window at Carmel Dental Clinic

Why it feels worse at night

Lying down increases blood flow to the head, and an inflamed nerve inside a tooth sits in a rigid space with no room to swell. More pressure on it means more pain. There are also fewer distractions at night, so the same pain simply feels louder.

That is why a tooth that was a dull ache during the day can throb at 2 am. The worsening is real, but it does not always mean the problem has suddenly become more serious.

The usual causes

Several different problems produce similar pain, which is why a toothache needs examining rather than guessing.

Deep decay reaching the nerve. Often starts as sensitivity to sweet or cold and turns into lingering, throbbing pain.
An inflamed nerve. Pain that lingers for minutes after something hot or cold, or that starts on its own, usually points here.
An abscess. A deep, constant throb, pain on biting, and sometimes swelling of the gum or face.
A cracked tooth. Sharp pain when biting down or releasing the bite, often hard to pin to one tooth.
Gum infection around a wisdom tooth. Pain and swelling at the back of the mouth, sometimes with difficulty opening wide.
Clenching or grinding. A dull ache across several teeth or the jaw, often worst on waking.
Sinus congestion. An ache across the upper back teeth, usually with a blocked nose and pain when bending forward.

What you can do until you are seen

These ease the pain. None of them treats the cause.

1
Take a painkiller as directed
An over-the-counter painkiller you have taken safely before, exactly as the packet says. Do not take more than the stated dose because the pain is bad.
2
Keep your head raised
An extra pillow reduces the pressure that makes night-time toothache worse.
3
Rinse with warm salt water
Half a teaspoon of salt in a glass of warm water. It will not cure an infection, but it keeps the area clean and can ease sore gums.
4
Use a cold pack on the cheek
Wrapped in a cloth, twenty minutes on and twenty minutes off. Never put heat on a swollen face.
5
Avoid the triggers
Very hot, very cold and sweet food and drink, and chewing on that side.

Do not hold a painkiller tablet against the gum

Aspirin or any other tablet placed next to the tooth does not work there, and it can burn the gum. Swallow painkillers as directed on the packet.

When it cannot wait until morning

Go to a hospital casualty department straight away if any of these apply.

Swelling of the face or under the jaw that is spreading, or reaching towards the eye or down the neck.
Difficulty breathing, swallowing or opening your mouth.
A high temperature together with the toothache and swelling.
Bleeding from the mouth that does not stop with firm pressure.

Questions we are actually asked

Can antibiotics fix a toothache?

Usually not. Antibiotics can help control an infection that is spreading, but they do not treat the cause inside the tooth, so the pain tends to return when the course ends. Leftover or borrowed antibiotics should never be taken without an examination and a prescription.

The pain stopped on its own. Do I still need to come in?

Yes. When severe toothache stops suddenly, it can mean the nerve inside the tooth has died. The infection can carry on without pain and return later as an abscess. An examination tells you which it is.

Does clove oil help?

A small amount on a cotton bud, applied to the tooth, can numb it briefly, and many people find it helps. Keep it off the gums, where it can irritate, and treat it as temporary relief rather than treatment.

Where it usually leads

Root canal treatmentWhen the nerve is inflamed or infected and the tooth can be saved. Tooth extractionWhen a tooth cannot reasonably be saved, including wisdom teeth. Dental emergencyWhat counts as urgent, and what to do right now.

In pain now?

Call the clinic when it opens and say you are in pain. Getting you out of pain comes before anything else.

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This page describes a dental procedure in general terms. It is not a diagnosis and not a treatment plan, and outcomes vary from person to person. What is right for you is decided after a clinical examination at the clinic. See our terms and medical disclaimer.