A glass of water and soft toothbrush on a bathroom shelf

Quick answer

Toothache feels worse at night because lying down increases blood pressure in the head, amplifying pressure inside an inflamed tooth. Pain that wakes you, throbs with your pulse, or lingers after hot drinks usually signals inflammation of the tooth's nerve, which will not settle on its own. Take paracetamol or ibuprofen as directed, keep your head elevated, and call a dentist in the morning; same-day emergency appointments exist for exactly this. Facial swelling or difficulty swallowing needs urgent care immediately.

Why it's worse when you lie down

Horizontal, more blood reaches your head, and the pressure inside an inflamed tooth rises. A tooth that murmured all day can pound all night. There's also nothing to distract you at 2am, but the mechanism is real, not imagined.

What the pain pattern is telling you

  • Sharp twinge with cold or sweet, gone in seconds: often early decay or a leaking filling. Book soon; the fix is small right now.
  • Lingering ache after hot drinks: hot-sensitivity that lingers suggests the nerve is inflamed. Book this week, not this month.
  • Spontaneous throbbing, wakes you at night: classic irreversible pulpitis or infection. This does not self-resolve. Call us in the morning.
  • Pain on biting: possibly a cracked tooth or an abscess at the root tip. Needs an examination and usually an X-ray.
  • Pain plus facial swelling: infection spreading. Same-day care, and if swelling affects your eye or throat, or you have trouble swallowing or breathing, go to an emergency department now.

Safe relief tonight

  • Paracetamol or ibuprofen as directed on the packet (they can be alternated; ask your pharmacist)
  • Sleep with your head propped up on an extra pillow
  • Cold compress on the cheek for ten minutes at a time
  • Rinse gently with warm salty water
  • Avoid: heat packs on a swollen face, and never hold aspirin against the gum, it burns the tissue
Painkillers treat the messenger, not the message. A toothache that needed root canal treatment last week still needs it after a fortnight of ibuprofen, plus, by then, sometimes an extraction instead.

What happens when you call us

Call (02) 9723 5757 as early in the day as you can. We triage honestly, keep emergency time in the book, and will usually see genuine dental pain the same day. The visit covers examination, any X-ray needed and getting you out of pain; anything further is quoted in writing before it happens.