Why toothaches get worse at night, and what helps until morning

Written and clinically reviewed by Dr. Andrew Korcek, DDS, FAGD  ·  Korcek Dental, Minden, Nevada

Why lying down makes it worse

Inside a tooth is a sealed chamber of pulp tissue with nowhere to expand. When that tissue is inflamed it swells against rigid dentine, and the pressure is the pain. Lying flat increases blood flow to the head, and that additional pressure has nowhere to go.

The second reason is simpler. During the day you are distracted. At 2am there is nothing else competing for your attention.

What actually helps overnight

• •Prop your head up. An extra pillow or two genuinely reduces the pressure. This is the single most effective thing on this list.
• •Ibuprofen, not aspirin. Ibuprofen is anti-inflammatory, which targets the mechanism. Follow the packet dosing.
• •Cold, not heat. A cold compress on the outside of the cheek. Heat increases blood flow and makes it worse.
• •Salt water rinse. Warm, not hot. Helps if there is debris or gum irritation involved.
• •Avoid chewing on that side, and skip anything very hot, very cold, or very sweet.

What not to do

• •Do not hold aspirin against the gum. It is an acid and it burns the tissue.
• •Do not apply heat to a swollen face.
• •Do not wait it out if the pain stops suddenly and swelling appears. That combination usually means the nerve has died and infection is spreading.