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Tooth pain can feel especially intrusive at night, when there are fewer distractions and it interferes with sleep. Some people also notice more throbbing when lying down. The intensity or timing of pain cannot identify the cause, however. Toothache may come from decay, an inflamed or infected dental pulp, a cracked tooth, gum problems, a wisdom tooth or another condition.
Temporary comfort measures may help you get through the night, but recurring, severe or worsening pain needs a dental assessment. Pain relief alone does not treat the underlying cause.
First, check for emergency warning signs
Call 995 or go to the nearest A&E department now if there is:
- difficulty breathing, choking or difficulty swallowing;
- rapidly increasing or significant swelling of the face, mouth, throat or neck;
- major facial or jaw trauma;
- heavy bleeding from the mouth that does not stop with firm pressure;
- loss of consciousness or other concerning symptoms after a head or facial injury; or
- another situation that appears immediately life-threatening.
A toothache without life-threatening features is generally best assessed by a dentist. Seek urgent dental care for severe or worsening pain, swelling, fever or feeling unwell, difficulty opening the mouth, a painful broken tooth, a knocked-out permanent tooth, or concerning symptoms after dental treatment.
For the complete triage guide, read Tooth Pain and Dental Emergencies: What to Do and When to Seek Urgent Care.
Why can toothache seem worse at night?
Pain may be more noticeable when the day becomes quiet and there are fewer competing sensations. Lying flat may also change pressure and blood flow around an inflamed area for some people. These possibilities do not establish a diagnosis, and pain that improves after sitting up does not mean the dental problem has resolved.
Patterns can sometimes help the dentist—for example, whether pain is spontaneous, triggered by hot or cold, worse on biting, or associated with swelling—but an examination and sometimes an X-ray are needed to determine the cause.
Safe steps while arranging dental care
Keep the area gently clean
Rinse gently with warm water. Brush carefully and floss if food appears trapped between the teeth, but do not force floss or objects beneath the gum.
Avoid triggers
Choose soft foods and avoid chewing on the painful side. Very hot, cold or sugary food and drinks may aggravate some toothaches.
Use a cold compress when appropriate
If there is swelling or a recent injury, place a wrapped cold compress on the outside of the face for short periods. Do not apply ice directly to the skin, and do not apply heat to facial swelling.
Consider non-prescription pain relief safely
Follow the product label. Check with a pharmacist or doctor before taking a medicine if you have allergies, medical conditions, take other medicines, are pregnant or breastfeeding, or are unsure what is safe. Do not exceed the labelled dose or combine products without checking their ingredients.
Rest with your head supported
Some people find that resting more upright is more comfortable than lying completely flat. This is a comfort measure only and should not delay care.
What should you avoid?
- Do not place aspirin, pain-relief tablets, essential oils or other chemicals directly on the tooth or gum; they can injure the tissue.
- Do not use antibiotics left over from an earlier illness or prescribed for someone else.
- Do not attempt to drain a swelling or repair a tooth yourself.
- Do not ignore pain because it temporarily disappears. A damaged or infected tooth can still require treatment.
Antibiotics are not routinely the answer to toothache. Many dental conditions require treatment of the tooth or source of infection. A dentist decides whether antibiotics are indicated based on the diagnosis and signs such as systemic involvement or spreading infection.
What could be causing the pain?
Common possibilities include:
- tooth decay extending towards the dental pulp;
- inflammation or infection inside a tooth;
- a cracked, chipped or fractured tooth;
- an abscess around a tooth or gum;
- an inflamed or impacted wisdom tooth;
- gum inflammation or food trapped around a tooth;
- teeth grinding or jaw-muscle pain; and
- pain referred from another area.
These conditions can feel similar. Avoid trying to select your own treatment based only on online descriptions.
What happens at the dental appointment?
The dentist will ask where the pain is felt, when it started, what triggers it, whether it wakes you, and whether swelling, fever, trauma or recent treatment is involved. They will also review your medical conditions, allergies and medicines.
The examination may include checking the teeth, gums and bite, testing the suspected tooth and taking an X-ray when indicated. Depending on the diagnosis, treatment might involve a restoration, drainage, root canal treatment, extraction, management of a wisdom tooth, or referral. The dentist should explain the findings, reasonable options and relevant fees before treatment.
Learn more about root canal treatment and wisdom tooth assessment and surgery.
Frequently asked questions
Can I wait until morning?
That depends on the symptoms. The emergency signs above require immediate help. Severe pain, swelling, fever, trauma or worsening symptoms warrant urgent professional advice. If none is present, use safe temporary measures and contact a dentist as soon as the clinic opens.
Why did the pain suddenly stop?
Symptoms can fluctuate, and a reduction in pain does not confirm that the cause has resolved. Arrange an assessment if the pain was severe, persists, returns or is associated with swelling or tenderness.
Will a dentist prescribe antibiotics?
Not necessarily. Many toothaches need dental treatment rather than antibiotics. The dentist will decide after assessing the cause and whether there are clinical indications for an antibiotic.
Arrange an assessment
When booking, describe the severity, swelling, fever, trauma and how long the pain has been present so the clinic team can guide you towards an appropriate appointment.
General information only. This article does not replace an individual examination, diagnosis or treatment plan. For emergencies in Singapore, call 995.
Sources for clinical review
- Teeth Q: Tooth Pain and Dental Emergencies
- NHS: Toothache
- Singapore Civil Defence Force: Emergency Medical Services
- American Dental Association: Antibiotics for dental pain and swelling
