A tooth that lets you get through the day but keeps you awake at night is most often one with an inflamed nerve, an infection at the root, or a crack. Food packed under the gum, a lost filling and a sore wisdom tooth are common too. The kind of pain you feel, and what sets it off, gives useful clues to which of these it is, although only an examination and usually an X-ray can confirm it.
This page focuses on the likely causes. For an hour-by-hour plan for tonight, see what to do about tooth pain at night, and for the reasons pain feels stronger once you lie down, see why toothache is worse at night.
An ache that lingers or wakes you: the nerve is inflamed
The nerve and blood supply in the centre of a tooth, the pulp, sit inside rigid walls of dentine and enamel. When deep decay, a crack, a large or leaking filling or repeated dental work irritates the pulp, it becomes inflamed, a condition called pulpitis. There is little room for swelling, so the pain can be intense.
A short, sharp twinge with cold that disappears within seconds usually points to sensitive exposed dentine or early irritation. An ache that lingers after hot or cold, comes on by itself, or wakes you from sleep suggests the inflammation is more advanced. Pain like this tends to need root canal treatment or, if the tooth cannot be saved, removal.
Throbbing and tender to bite on: infection at the root
When the pulp dies, infection can spread out of the root tip into the bone, forming an abscess. The tooth may stop reacting to cold but become tender to touch or bite on, and the pain is often a steady throb. A small pimple on the gum, a bad taste or swelling of the gum or face are further signs. An abscess will not clear up on its own, even if the pain settles for a while.
Sharp pain on biting or letting go: a cracked tooth
A crack often causes a sudden sharp pain when you bite on something firm, or as you release the bite, with sensitivity to cold. It may come and go for weeks. Cracks can spread, and if one reaches the nerve, the tooth can move on to constant night pain. Our article on cracked tooth syndrome explains how these are found and treated.
Other causes that flare at night
A lost or broken filling or crown
Exposed dentine reacts to temperature, sweet food and air, and the area traps food. Our guide to a lost filling or crown covers the first steps.
Food wedged between teeth or under the gum
A popcorn husk or fibre stuck at the gum line can cause a surprisingly strong ache and gum swelling. Gentle flossing often settles it. See food stuck between your teeth if it keeps happening in the same spot.
A partly erupted wisdom tooth
Gum over a wisdom tooth that has only partly come through can become inflamed and infected, causing pain at the back of the jaw, a bad taste and difficulty opening wide. This is called pericoronitis, explained in our article on wisdom tooth gum infection.
Clenching or grinding in your sleep
Heavy clenching can leave teeth and jaw muscles sore, typically worse on waking. The ache is often spread over several teeth rather than one.
Sinus pressure
A blocked or infected sinus can make several upper back teeth ache together, often worse when lying down or bending forward, usually alongside a blocked nose. The teeth themselves may be healthy.
Getting through to the morning
Sleeping with your head raised on extra pillows, taking over-the-counter pain relief exactly as the packet directs, holding a cold pack against the cheek and rinsing with warm salty water can make the night more bearable. Avoid very hot, cold or sweet food on that side. Do not hold aspirin against the gum, as it can burn the tissue. These steps ease the symptoms only; the cause still needs treatment, even if the pain fades by morning.
Signs that cannot wait until the morning
Go to a hospital emergency department or call 000 if you have swelling spreading towards the eye or down the neck, difficulty swallowing or breathing, or a high fever with facial swelling. These can mean a dental infection is spreading. Facial or gum swelling without those signs, pain that pain relief does not touch, or a tooth broken by an injury should be seen by a dentist the same day where possible.
Why night pain is worth acting on
Pain that wakes you usually means the nerve is involved or infection is present. Even when it eases, the cause remains and tends to return. Being seen early often means a smaller and more comfortable treatment than waiting for the pain to come back more severely.
If a tooth is keeping you awake, Lumi Dental offers emergency appointments, and a general dentist can find the cause and explain your options. Any current offers are on our current deals page.
Questions about night-time toothache
Will it settle by itself?
The pain sometimes fades, particularly if the nerve dies, but decay, cracks and infection do not heal on their own. A tooth that stops hurting can still have an infection developing at the root.
Is night pain always serious?
Not always. Food trapped at the gum or a sensitive spot can feel worse at night. A lingering ache that wakes you, swelling or a tooth that is tender to bite on all suggest something that needs treatment soon.
This article is general information and is not a substitute for an in-person assessment. If you are in significant pain or have spreading swelling, seek care promptly.
