Many people find a toothache that was manageable during the day becomes much harder to ignore once they lie down. Part of this is physical: lying flat increases blood flow to the head, which can raise pressure around an already inflamed tooth or gum. Part of it is simply that there are fewer distractions at night, so pain that was there all along becomes more noticeable. Clenching the jaw while asleep can also make things worse.
Over-the-counter pain relief such as paracetamol or ibuprofen, taken exactly as described on the packet, is usually the first thing to try. Do not exceed the stated maximum dose, and check the packet or ask a pharmacist if you have any medical conditions, take other medication, or are unsure whether a particular painkiller is suitable for you. Never place aspirin or any tablet directly against the gum or tooth, as this can burn the soft tissue.
A warm salt water rinse (a teaspoon of salt dissolved in a glass of warm water) can help reduce inflammation and clear away any trapped food or debris that may be contributing to the pain. A cold compress held against the outside of the cheek, not directly on the tooth, can also help with discomfort. Avoid heat on the face, such as a hot water bottle, as this can increase blood flow to the area and may make swelling worse rather than better.
If the pain is mild to moderate, is controlled reasonably well by painkillers, and there is no swelling, fever or other symptoms, it is generally reasonable to manage it overnight using the steps above and contact a dentist as soon as you can the next day.
Some symptoms mean you should not wait. Seek urgent help, rather than waiting for a routine appointment, if you have:
Swelling that is spreading, or any difficulty breathing or swallowing, can be a sign of infection moving beyond the tooth and needs same-day assessment, sometimes at a hospital emergency department rather than a dental surgery. If you’re not sure how serious it is, it’s safer to get it checked than to assume it will settle. Our Emergency Dentist page explains what to expect if you need to be seen urgently.
Toothache that throbs, is brought on by hot or cold and lingers well after the stimulus has gone, or that regularly wakes you at night, can sometimes point to the nerve inside the tooth being affected. This is something a dentist needs to examine and assess properly, as it can’t be judged from symptoms alone. If the nerve is involved, one possible treatment a dentist may discuss with you is root canal treatment, though this depends entirely on what’s found on examination and an x-ray.
Enhance Dental, at 26 High Street, High Wycombe, treats both NHS and private patients and is open Monday to Friday, 9am to 5pm. If your toothache starts or continues during these hours, call 01494 524455 to arrange an appointment. If it’s outside these hours and your symptoms are severe or getting worse, particularly with swelling, fever, or difficulty breathing or swallowing, contact NHS 111 or your nearest emergency department rather than waiting until the next working day.
No, you should not exceed the maximum dose stated on the packet, even if the pain is severe. If paracetamol or ibuprofen alone isn't helping, ask a pharmacist whether it's safe for you to take both together, and see a dentist as soon as possible as this usually means the underlying cause needs treating.
It's best avoided. Heat applied to the face can increase blood flow to the area, which may increase swelling or discomfort rather than ease it. A cold compress held against the outside of the cheek is generally safer for tooth-related pain.
Toothache alone usually doesn't need A&E, but facial swelling that's spreading, a high temperature, or difficulty breathing or swallowing are signs of a more serious infection and do need urgent assessment, sometimes at an emergency department. If you're unsure, NHS 111 can help you decide.
It might ease temporarily, especially with painkillers, but this doesn't mean the underlying problem has resolved. Toothache usually has a cause that needs a dentist to examine and treat, so it's worth arranging an appointment even if the pain settles down overnight.
Written for Enhance Dental, Cosmetic and Training Centre. General information, not a diagnosis – if something is troubling you, call us on 01494 524455.
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