There’s a particular cruelty to a toothache at night. All day it was a dull nuisance you could half-ignore, and then the moment your head hits the pillow, it becomes a throbbing, pulsing thing that makes sleep impossible. If you’re reading this at 2 a.m., you have my sympathy – and some practical help.
Let’s get you through until you can be seen. Then let’s talk about why this happens, because understanding it makes it a little less maddening.
What actually helps, right now
Take an anti-inflammatory pain reliever. Ibuprofen tends to work better than acetaminophen for dental pain because it targets the inflammation that’s driving it. Take it as directed on the label – and don’t exceed the dose, even though you’re tempted to.
Rinse with warm salt water. Dissolve about half a teaspoon of salt in a glass of warm water and swish gently. It’s simple, and it genuinely helps clean the area and calm inflamed tissue.
Prop your head up. This is the one most people miss. Lying flat sends more blood to your head, which increases the pressure around an inflamed tooth and cranks up the throbbing. Sleep – or try to – propped on a couple of extra pillows.
Use a cold compress. Hold a cold pack against your cheek over the sore area for 15 to 20 minutes. It numbs the pain and reduces swelling.
Avoid the triggers. Avoid hot, cold, or sugary foods and drinks, and chew on the other side. If something’s stuck between the teeth, a gentle floss might bring relief.
One thing NOT to do
Don’t put an aspirin directly on the gum next to the sore tooth. It’s an old folk remedy, and it doesn’t work the way people think – aspirin is acidic and will actually burn the gum tissue. Swallow the pain reliever; don’t apply it.
Why does it always get worse at night?
Two reasons, and neither is your imagination. First, that lying-down effect – more blood flow to the head means more pressure on an already-angry tooth. Second, at night there’s nothing to distract you. All day your brain was busy; now it’s quiet and dark, and the pain has the floor to itself. Put those together and a manageable daytime ache becomes a night-time ordeal.
When you shouldn’t wait for morning
Home measures are for getting through the night – not for treating the cause. And some symptoms mean you shouldn’t wait at all. Seek urgent or emergency care if you have facial or jaw swelling, a fever along with the tooth pain, a bad taste or discharge (a possible abscess), or pain so severe that nothing touches it. And if you ever have difficulty breathing or swallowing, go to an emergency room immediately – that’s a sign of a spreading infection.
The bottom line
Ibuprofen, a warm salt rinse, your head propped up, and a cold compress will usually get you to morning. But the tooth still needs attention – whatever’s causing the pain, whether decay, a crack, or infection requiring a root canal, won’t fix itself. Call your dentist first thing. If you’re near Marlborough, we keep room for same-day emergencies; reach us at (508) 290-8714.
Now put the phone down and try that cold compress.
