Why does toothache get worse at night?

Why toothache feels worse at night

• Lying down: when you lie flat, more blood flows to the head.  The extra pressure inside an inflamed tooth can make a throbbing pain stronger.
• Fewer distractions: in the quiet of the night, pain is harder to ignore.
• Clenching or grinding: many people clench or grind their teeth in their sleep, which puts extra load on a sore or cracked tooth.

What can cause toothache at night?

• Irreversible pulpitis: inflammation of the pulp that will not settle.  The pain often starts on its own, lingers after hot or cold, and can wake you at night.
• A tooth abscess: infection at the root tip, causing a throbbing pain, pain on biting, and sometimes swelling.
• A cracked tooth: often sharp pain on biting, made worse by grinding at night.
• Sinus pressure: a sinus infection can cause an ache in the upper back teeth that is worse when lying down.  Several teeth often feel sore at once.

Read more in my guides to pulpitis, tooth abscesses and cracked teeth.

Toothache only at night

Pain that comes on mainly at night, or wakes you up, usually points to a problem with the pulp rather than with the gum or the surface of the tooth.  Pain that wakes you up is one of the signs that pulpitis is unlikely to settle, and the tooth should be assessed.

How to manage toothache at night

• Take over-the-counter pain relief such as paracetamol or ibuprofen, as directed on the pack
• Raise your head with an extra pillow
• Avoid very hot, cold or sweet food and drink
• Avoid chewing on the painful side

These steps can ease the pain, but they do not treat the cause.

How is toothache at night treated?

The treatment depends on the cause.  An examination, X-rays and a CBCT scan where needed help to find which tooth is responsible and why.  When the pulp is irreversibly inflamed or infected, root canal treatment removes the source of the pain and allows the tooth to be kept.

When is toothache at night urgent?

Seek urgent medical help, or go to A&E, if you have swelling that spreads to the eye or neck, difficulty swallowing or breathing, or a high temperature with the swelling.

Frequently asked questions

Why does my tooth only hurt when I lie down?
Lying flat increases blood flow to the head, which raises pressure inside an inflamed tooth.  Pain that changes with position often comes from the pulp, or sometimes from the sinuses.

Can toothache at night go away on its own?
The pain may ease for a while, but the cause is usually still there.  If the pulp dies, the pain can stop and then return later as an abscess.

Should I see a dentist if the pain has stopped?
Yes.  Toothache that stops suddenly can mean the pulp has died, and a dead tooth can still become infected.  Read more in my guide to a dead tooth.