There is something particularly miserable about severe toothache at night. The house is quiet, you are exhausted, and the pain seems to grow louder with every passing minute. If you have ever wondered why does my tooth hurt more at night, you are certainly not alone. It is one of the most common questions patients ask when they contact us.
The answer lies in how your body behaves when you lie down. Changes in blood flow, pressure, and even the simple absence of daytime distractions all play a role in making dental pain feel significantly worse after dark.
The good news is that there are practical steps you can take to find nighttime tooth pain relief before your appointment. And when the pain points to something more serious, professional help is available — even outside regular hours. If you are struggling right now, our severe toothache relief service is designed for exactly this situation.
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Why Does Severe Toothache at Night Feel Worse?
Severe toothache at night feels worse because lying down increases blood flow to the head, raising pressure around an already inflamed or infected tooth. Without daytime distractions, your brain focuses more on pain signals. The combination of increased pressure and heightened awareness makes dental pain feel noticeably more intense after dark.
Understanding why this happens can help you manage the discomfort more effectively. There are several reasons your tooth pain intensifies at night.
Increased blood flow when lying down. During the day, gravity helps keep blood distributed throughout your body. When you lie flat, blood flows more freely to your head. If a tooth is inflamed or infected, this extra blood flow increases pressure inside and around the tooth. The result is a deeper, more persistent throb.
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Book an appointment with our team →Pressure changes. The tissues around an infected or irritated tooth are already swollen. Lying down with toothache adds further pressure to these tissues, compressing nerves and amplifying the pain signal. Even a slight positional change can make the difference between a dull ache and a sharp, pulsing sensation.
Lying down with toothache increases throbbing. The throbbing quality of nighttime dental pain is directly linked to your pulse. When you are flat, each heartbeat pushes a small wave of blood into the inflamed area. You feel it as a rhythmic throb that can make it impossible to fall asleep.
Reduced distractions at night. During the day, work, conversation, and activity occupy your attention. At night, with nothing else to focus on, your brain amplifies pain signals. This is not imagined — it is a well-documented neurological response. The pain has not actually changed in intensity; your perception of it has.
Pulpitis Symptoms — A Common Cause of Night Pain
One of the most frequent reasons for severe toothache at night is a condition called pulpitis. This occurs when the pulp — the soft tissue inside your tooth containing nerves and blood vessels — becomes inflamed.
Pulpitis symptoms can range from mild sensitivity to intense, prolonged pain. Here is what to look out for:
- Sharp, throbbing pain that seems to come from deep within the tooth
- Sensitivity to hot and cold that lingers long after the trigger is removed
- Pain that wakes you from sleep or prevents you from falling asleep
- Tooth sensitivity at night that is noticeably worse than during the day
- Pain that spreads to the jaw, ear, or temple on the same side
There are two types of pulpitis. Reversible pulpitis causes brief sensitivity — typically a sharp twinge when you eat something cold or sweet — that settles quickly. This type can often be treated with a filling.
Irreversible pulpitis is more serious. The pain is prolonged, spontaneous, and often worse at night. It means the nerve inside the tooth is damaged beyond recovery and will need root canal treatment or extraction to resolve.
If these pulpitis symptoms sound familiar, our guide on understanding tooth nerve pain — triggers and treatments explains the condition in more detail.
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Other Causes of Severe Toothache at Night
Pulpitis is not the only reason your tooth might be keeping you awake. Several other dental conditions are known to cause or worsen nighttime pain.
Dental Abscess
A dental abscess is a pocket of pus caused by bacterial infection. It can form at the tip of the tooth root or in the gum tissue beside it. The pressure from the trapped infection causes deep, constant pain that is often described as throbbing or pounding.
Lying down with toothache caused by an abscess tends to make the pain worse, as blood flow to the area increases. You may also notice swelling in the gum, a bad taste, or facial puffiness. An abscess will not resolve on its own and needs professional treatment. Our emergency dental abscess treatment service can help.
Cracked or Broken Tooth
A crack in a tooth may not always be visible, but it can cause significant pain — especially at night. The crack allows bacteria and temperature changes to reach the nerve, triggering sharp, intermittent pain. Biting down on the tooth during sleep, particularly if you clench or grind, can send jolts of pain through the jaw.
Night throbbing from a cracked tooth is a sign that the crack may be deepening or that the nerve is becoming inflamed. Early assessment can often save the tooth. Visit our emergency broken tooth repair page for more information.
Wisdom Tooth Problems
Partially erupted wisdom teeth are particularly prone to causing nighttime discomfort. The gum tissue around a partially emerged wisdom tooth can become inflamed and infected — a condition called pericoronitis. The resulting pain and swelling tend to feel worse at night when you are lying down.
Repeated episodes of inflammation around wisdom teeth are a common reason for seeking urgent care. Our wisdom tooth pain relief service provides same-day assessment and treatment options.
Nighttime Tooth Pain Relief — What You Can Do Before Sleep
When severe toothache at night strikes and your dental appointment is not until the morning, there are several safe steps you can take for temporary relief. These measures are designed to help you get through the night more comfortably. They are not a substitute for professional treatment, but they can make a meaningful difference.
Elevate your head. Prop yourself up with an extra pillow or two. Keeping your head above the level of your heart reduces blood flow to the area and can lessen the throbbing sensation. This is one of the simplest and most effective ways of minimising discomfort before sleep.
Avoid hot drinks and food. Heat increases blood flow and can intensify inflammation. Stick to cool or room-temperature drinks in the evening. Avoid anything very cold as well if your tooth is sensitive to temperature.
Gentle saltwater rinse. Dissolve half a teaspoon of table salt in a glass of warm water. Swish gently around the affected area for 20 to 30 seconds and spit. This can help reduce bacterial load and ease gum inflammation. Do not rinse aggressively.
Pain relief medication. Over-the-counter painkillers such as ibuprofen can help manage dental pain. Ibuprofen is often preferred because it targets both pain and inflammation. Follow the dosage instructions on the packaging carefully and do not exceed the recommended amount.
Avoid lying on the painful side. If one side of your mouth is affected, try to sleep on the opposite side to reduce direct pressure.
These steps provide temporary nighttime tooth pain relief only. If the pain returns the following night or is worsening, professional assessment is needed. For more detailed advice, read our guide on how to stop tooth pain fast.
When Severe Toothache at Night Becomes an Emergency
Most nighttime dental pain, while deeply unpleasant, can be managed until the morning with the steps above. However, certain signs indicate that the situation is more serious and may need urgent attention from an emergency dentist for night pain.
Seek urgent care if you experience any of the following alongside your toothache:
- Facial swelling that is spreading or getting noticeably worse
- A raised temperature alongside dental pain
- Difficulty swallowing or a feeling of tightness in the throat
- Constant pain that does not respond to over-the-counter medication
- Bleeding that will not stop from the gum or a damaged tooth
These symptoms can indicate a spreading infection that needs prompt professional intervention. Do not wait until morning if you are concerned.
Our out-of-hours emergency dentist service provides access to urgent dental care outside regular clinic hours. We also offer weekend emergency dentist appointments for patients who need Saturday or Sunday care.
How an Emergency Dental Appointment Helps
When nighttime tooth pain relief measures are no longer enough, a professional assessment will get to the root of the problem — quite literally in many cases.
Diagnosis. The dentist will examine the tooth and surrounding tissue, ask about your symptoms, and review your dental history. This helps narrow down the cause quickly.
X-ray if required. A digital X-ray may be taken to reveal what is happening beneath the surface — an abscess at the root tip, a deep crack, or bone loss around the tooth. This step is quick and provides essential information for treatment planning.
Immediate treatment options. Depending on the diagnosis, several treatments may be available on the same day. If the nerve is infected, a root canal treatment removes the infected tissue and relieves pain at the source. If an abscess is present, drainage provides rapid pressure relief. In cases where the tooth cannot be saved, extraction is carried out to prevent further infection.
The goal is always to resolve the cause of your severe toothache at night, not simply to mask the symptoms. Once the underlying issue is addressed, the nighttime pain stops.
Preventing Night Tooth Pain in the Future
While not every case of nighttime dental pain is preventable, many are. Taking a proactive approach to your dental health can significantly reduce the chances of being woken by a throbbing tooth.
Treat cavities early. A small cavity is easy to fill and painless to treat. Left alone, it grows deeper, eventually reaching the nerve — which is when the real pain begins, often at night.
Attend regular check-ups. Routine examinations catch problems before they become emergencies. Issues like early-stage pulpitis, hairline cracks, and developing abscesses can all be identified and treated at a stage when they are far simpler to manage.
Do not delay if you notice pulpitis symptoms. Sensitivity to hot or cold that lingers, or spontaneous twinges of pain, are early warning signs. Addressing them promptly can prevent the condition from progressing to the stage where it disrupts your sleep.
Maintain good oral hygiene. Brushing twice daily with fluoride toothpaste and cleaning between your teeth reduces your risk of decay and gum disease — both of which can lead to nighttime pain.
Avoid clenching and grinding. If you clench your jaw or grind your teeth during sleep, you may be putting excessive pressure on teeth that are already compromised. A custom-made night guard can protect your teeth and reduce morning jaw pain.
Frequently Asked Questions
Why does my tooth hurt more at night?
Your tooth hurts more at night primarily because lying down increases blood flow to your head. This raises the pressure inside and around an inflamed or infected tooth, intensifying the pain. The throbbing sensation you feel is your pulse pushing blood into the swollen tissue with each heartbeat.
There is also a neurological element. During the day, your brain is occupied with work, conversation, and daily tasks. At night, with fewer distractions, your awareness of pain signals increases. The pain has not necessarily worsened — but your perception of it has sharpened.
Elevating your head with extra pillows and taking appropriate pain relief before bed can help reduce nighttime discomfort.
Is severe toothache at night a sign of infection?
It can be, but not always. Severe toothache at night is commonly caused by pulpitis — inflammation of the nerve inside the tooth. This can result from deep decay, a crack, or a large filling close to the nerve. Pulpitis does not always mean infection is present, but it does mean the nerve is under stress.
If your nighttime pain is accompanied by swelling, a bad taste, facial puffiness, or a raised temperature, infection is more likely. A dental abscess, for example, causes constant throbbing that worsens when lying down.
If you suspect infection, it is important to seek professional assessment rather than relying on home remedies alone.
What is the best nighttime tooth pain relief?
The most effective nighttime tooth pain relief combines several approaches. Take ibuprofen as directed on the packaging to reduce both pain and inflammation. Elevate your head with an extra pillow to limit blood flow to the affected area. Avoid hot food and drinks in the evening, and rinse gently with warm salt water before bed.
These steps can help you manage the discomfort enough to get some rest. However, they provide temporary relief only. If the pain returns the following night, professional treatment is needed to address the underlying cause.
Can pulpitis symptoms get worse at night?
Yes. Pulpitis symptoms frequently feel worse at night. The increased blood pressure in the head when lying flat puts additional strain on the inflamed nerve tissue. If you have irreversible pulpitis, the pain may become spontaneous — occurring without any trigger — and is often at its worst during the night.
Reversible pulpitis, which causes brief sensitivity, is less likely to disturb your sleep. But if you notice that tooth sensitivity at night is becoming more intense or lasting longer, it may be progressing. Early treatment gives you the best chance of saving the tooth and stopping the pain.
When should I see an emergency dentist for night pain?
You should see an emergency dentist for night pain if the pain is severe and constant, if it does not respond to over-the-counter painkillers, or if it is accompanied by swelling, a raised temperature, or difficulty swallowing. These signs suggest the problem may need urgent intervention rather than waiting for a routine appointment.
If you have experienced several nights of worsening pain, that is also a strong reason to seek same-day care. The longer an inflamed or infected tooth is left, the more complex the treatment may become.
Our team is available for out-of-hours and weekend appointments, so you do not have to endure another sleepless night before getting help.