Toothache has a particular talent for arriving at the worst possible moment, and nighttime is its favourite. Understanding why toothache so often worsens at night, what you can do to get through it, and when the situation genuinely requires urgent attention can make a miserable experience more manageable.
There are two main reasons toothache tends to feel more intense when you lie down. First, when you are horizontal, blood flow to the head increases, which raises the pressure around an already-inflamed nerve. Second, the distractions of daily life disappear at night, leaving you with nothing but the pain.
Toothache that is noticeably worse lying down, or that keeps you awake, is often a sign that the pulp, the nerve tissue inside the tooth, is inflamed or infected. This type of pain tends to be more intense, more constant, and harder to manage with over-the-counter painkillers alone.
Dental decay. Decay that has reached the inner dentine layer causes sensitivity and pain, which worsens as it progresses towards the pulp.
Pulpitis. Inflammation of the pulp, often as a result of deep decay, causes severe, often throbbing pain that is worse at night and may radiate to the jaw, ear, or temple.
Dental abscess. An abscess is a bacterial infection at the root of the tooth or in the surrounding gum. It often causes severe, constant pain, swelling, and sometimes a fever. An abscess is a dental emergency.
Cracked tooth. A crack in the tooth can allow bacteria to reach the pulp and cause pain that is difficult to localise.
Bruxism. Tooth grinding, which often occurs during sleep, can cause a dull, widespread ache across multiple teeth and in the jaw muscles.
Over-the-counter ibuprofen is generally the most effective painkiller for dental pain because it reduces inflammation as well as pain. If ibuprofen is not suitable for you, paracetamol is an alternative. Do not place aspirin directly on the gum or tooth; it will not help and can burn the soft tissue.
Sleeping with your head elevated can reduce pressure around the affected tooth. Avoiding very cold, hot, or sweet foods and drinks will reduce triggering of the pain.
If the pain is severe, constant, or accompanied by swelling, fever, or difficulty swallowing, do not wait. These are signs of a spreading infection that requires urgent dental treatment.
At Berkhamsted Dental, we treat dental emergencies promptly. Call us on 01442 865 646 if you are in pain. Out-of-hours guidance is available for our patients. If you are experiencing severe swelling that is affecting your breathing, go directly to a&e.
Whether you’re booking your first appointment, have a question about our treatments, or simply want advice on your dental care — our friendly team is here to help.
