To sleep with tooth pain, take an anti-inflammatory like ibuprofen about 30 minutes before bed, prop your head up on an extra pillow, hold a cold pack on your cheek, and lie on the side that doesn’t hurt. These steps calm the throbbing long enough for you to rest, but they don’t treat the tooth itself.
Night toothaches are common because the problems behind them are common. About 1 in 5 adults aged 20 to 64 has at least one untreated cavity, and untreated decay is one of the most frequent reasons a tooth starts to ache.
Below, I’ll cover what helps tonight, why nights feel worse, what’s usually behind the pain, and the signs that mean it can’t wait until morning.
Key Takeaways
- An NSAID such as ibuprofen, taken before bed, is the best first step for most adults.
- Sleeping with your head raised and the sore side off the pillow takes pressure off the tooth.
- A cold pack on your cheek eases swelling, while heat can make it worse.
- Home remedies buy you time, but the tooth still needs a dentist.
- Swelling that spreads toward your eye or neck, a high fever, or trouble breathing or swallowing means go to the ER now.
How Do You Sleep With Tooth Pain?
You sleep with tooth pain by lowering the pressure and inflammation around the tooth before you lie down. The eight steps below work best in combination, and they’re the same ones I walk patients through when they call about a toothache that started the night before.
Take an anti-inflammatory before bed
Take ibuprofen or another NSAID (nonsteroidal anti-inflammatory drug) about 30 minutes before you lie down. NSAIDs, alone or paired with acetaminophen (Tylenol), are a recommended first option for a toothache when dental care isn’t immediately available.
NSAIDs ease swelling as well as pain, which is what an inflamed tooth needs. Follow the dose on the label, and check with a pharmacist first if you take blood thinners or have kidney problems or stomach ulcers.
Prop your head up
Use a second pillow or a wedge pillow so your head rests above your heart. Lying flat can increase blood flow to your head, and inside an inflamed tooth that extra pressure shows up as throbbing.
Sleep on the side that doesn’t hurt
Lie on your back or on the side opposite the painful tooth. This keeps your weight, and the pillow, off a jaw that’s already tender.
Hold a cold pack on your cheek
Wrap an ice pack or a bag of frozen peas in a thin towel and hold it on the outside of your cheek for about 20 minutes at a time. Cold narrows the blood vessels in the area, which reduces swelling and dulls the ache for a while. Keep ice off the tooth itself, since cold on an exposed nerve can set off a sharp jolt.
Rinse with warm salt water
Stir half a teaspoon of salt into 8 ounces of warm water, swish for 30 seconds, and spit. The rinse loosens trapped food and soothes irritated gums.
Clean around the tooth gently
Brush with a soft toothbrush and floss slowly around the sore spot. A popcorn hull or a sliver of food pressed against the gumline can cause surprisingly sharp pain, and clearing it out sometimes ends the ache completely.
Skip trigger foods after dinner
Avoid hot, cold, sugary, acidic, and hard foods in the hours before bed. Each one can set off a sensitive nerve right when you’re trying to fall asleep.
Try a numbing gel or clove oil
An over-the-counter benzocaine gel dabbed on the gum near the tooth numbs the area for a short time. It’s for adults and older children only, since oral benzocaine products shouldn’t be used in children younger than 2 because of a rare but serious blood reaction.
Clove oil is another option. It contains eugenol, a natural numbing agent dentists have used for generations. Mix a drop or two into a teaspoon of olive oil, dab it on the gum with a cotton ball, and don’t swallow it. Undiluted clove oil can irritate the gums.
Which toothache remedies can you use tonight?
The remedies you can use tonight are summarized below, so you can keep this open on your phone.
| Remedy | How to use it | Why it helps |
| Ibuprofen or another NSAID | As the label directs, 30 minutes before bed | Lowers pain and swelling |
| Extra pillows | Raise your head above your heart | Less pressure in the tooth |
| Cold pack | 20 minutes on the outer cheek, wrapped in a towel | Reduces swelling, dulls pain |
| Salt water rinse | 1/2 teaspoon salt in 8 ounces warm water, swish 30 seconds | Clears food, soothes gums |
| Benzocaine gel | A small amount on the gum near the tooth | Short-term numbing |
| Clove oil | 1 to 2 drops mixed into olive oil, on a cotton ball | Natural numbing from eugenol |
If the pain still breaks through, it helps to know why nights are so much harder than days.
Why Does a Toothache Get Worse at Night?
A toothache gets worse at night mostly because of how you lie and what you stop doing. The tooth doesn’t change at bedtime, but several things around it do.
- Blood flow: Lying flat lets more blood reach your head, which adds pressure on the nerve inside the tooth.
- Fewer distractions: With no work, screens, or conversation, your brain has nothing to focus on except the pain.
- Medicine wearing off: A dose you took at dinner may fade by midnight.
- Night grinding: Many people clench or grind in their sleep, which loads a tooth that’s already sore.
Knowing the reason helps, but the bigger question is what’s behind the pain in the first place.
What Causes Tooth Pain That Keeps You Up?
Tooth pain that keeps you up usually comes from a problem inside the tooth or in the gums around it. The cause matters because it decides which treatment fixes it.
- Cavity: Decay that reaches the inner layer of the tooth exposes the nerve to heat, cold, and sugar.
- Abscess: A pocket of infection near the root brings deep, throbbing pain, sometimes with a bad taste or a pimple-like bump on the gum.
- Cracked tooth: A crack may hurt only when you bite down or release, or it may ache all night.
- Grinding or clenching: Bruxism, the habit of grinding your teeth, strains teeth and jaw muscles overnight. A custom night guard protects your teeth while you sleep.
- Gum disease: Infected, swollen gums can make nearby teeth ache and feel loose.
After more than 25 years of treating toothaches, I can tell you a cracked tooth and an abscess often feel almost the same in the middle of the night. That’s why my first job at an emergency dental visit is pinning down which tooth is the source and why, and then walking you through your treatment options before anything begins. Some of these problems can wait until morning, and a few cannot.
When Is Nighttime Tooth Pain an Emergency?
Nighttime tooth pain is an emergency when it comes with spreading swelling, a high fever, or trouble breathing or swallowing. Those signs can mean a dental infection is spreading beyond the tooth, which needs an emergency room right away.
Go to the ER tonight if any of these are true.
- Spreading swelling: Your face is swelling toward your eye or down into your neck.
- Breathing or swallowing trouble: It’s hard to breathe or swallow.
- High fever: You have a fever above 101°F along with the tooth pain.
- Uncontrolled bleeding: Bleeding won’t stop after 15 to 20 minutes of firm pressure.
For other tooth pain, an emergency dentist is usually a better first stop than the ER, since a hospital can manage pain but can’t fix the tooth. Call a dentist first thing in the morning if the pain lasts more than a day or two, wakes you up, or comes back each time your pain reliever wears off.
Pain that suddenly stops isn’t always good news. It can mean the nerve inside the tooth has died while the infection around the root keeps growing. Until you can get in, a few common habits can make the night harder.
What Should You Avoid With a Toothache at Night?
With a toothache at night, avoid anything that adds heat, pressure, or irritation to the tooth. A few well-meant fixes backfire.
- Heat on your face: Warmth draws more blood to the area and can increase swelling.
- Aspirin against the gum: A pill held against the gum can burn the tissue. Swallow pain relievers as directed instead.
- Chewing on the sore side: Pressure can deepen a crack or irritate an inflamed nerve.
- Waiting it out: Pain from decay or infection rarely goes away for good on its own.
Get Some Rest Tonight, Then Get the Tooth Checked
The fastest way to get some sleep is to take pressure off the tooth with an anti-inflammatory, an extra pillow, a cold pack, and the right sleeping side. Those steps quiet the nerve for a few hours, but they don’t touch the decay, crack, or infection behind it.
That’s why the tooth still needs an exam, even if the ache has eased by morning. Problems like these usually get harder and more expensive to treat the longer they wait, so treating the tooth early often means a simpler visit.
Book a Same-Day Toothache Visit in West Houston
If a toothache kept you up last night, I’d like to see you today. At Roman Dental, my team works emergency patients into the schedule the same day whenever possible, and if you feel nervous about treatment, I also offer nitrous oxide, oral sedation, and IV sedation.
Book online anytime to request the earliest opening, or call (281) 920-4200 as soon as the office opens.
Frequently Asked Questions
What is the best sleeping position for a toothache?
The best sleeping position for a toothache is on your back or on the side that doesn’t hurt, with your head raised on an extra pillow. Keeping your head above your heart lowers pressure in the inflamed tooth.
Is ibuprofen or Tylenol better for tooth pain at night?
Ibuprofen is usually better than Tylenol for tooth pain at night because it reduces swelling as well as pain. Some adults get more relief by taking both, each at its labeled dose, but check with a pharmacist first if you take blood thinners or have kidney or stomach problems.
Can a toothache go away on its own?
A toothache can fade on its own, but the problem behind it usually doesn’t. Pain that stops suddenly can mean the nerve has died while the infection keeps spreading, so a tooth that hurt for days and then went quiet still needs an exam.
Can a toothache cause a headache or earache?
Yes, a toothache can cause a headache or earache, because pain from an upper or lower back tooth often spreads to the ear, jaw, or temple. If the ache sits on the same side as a sore tooth, the tooth may be the source even when the ear feels like the problem.
Does Roman Dental see toothache emergencies outside regular hours?
Yes, Roman Dental sees toothache emergencies outside regular hours, including weekends, when needed. My Houston office is open Monday to Thursday, 8 a.m. to 5 p.m., and Friday, 8 a.m. to 2 p.m., and you can book online 24/7 or call (281) 920-4200.
