Toothache at Night: Why It Gets Worse and When to See an Emergency Dentist (2026)

Last updated: January 2026. This guide provides NHS-verified information on managing toothache at night and when to seek emergency dental care.

If you've ever wondered why your tooth seems to hurt more intensely at night, you're not imagining it. Toothache worsening after dark is a real phenomenon with clear physiological explanations. More importantly, knowing when nighttime tooth pain requires urgent care—and when you can safely wait until morning—could protect your health.

This guide covers the science behind nighttime toothache, safe pain relief options, and exactly when you need emergency dental care.

Why Toothache Gets Worse at Night

Several factors combine to make dental pain more noticeable—and often more intense—once you lie down for bed.

Increased Blood Flow to Your Head

When you lie down, blood flow naturally increases to your head. This raises pressure around an inflamed or infected tooth, intensifying pain that was manageable during the day. A toothache that felt like a dull ache whilst you were upright can become sharp and throbbing once horizontal.

Direct Pressure from Your Sleeping Position

If you have toothache on one side of your mouth, sleeping on that side puts direct pressure on the affected area. This mechanical pressure can significantly worsen pain and make finding a comfortable position difficult.

Reduced Saliva Production

Your mouth produces saliva throughout the day to neutralise acids and wash away bacteria. At night, salivary production slows dramatically. This reduced protection can exacerbate pain from cavities, gum infections, or exposed tooth roots.

Fewer Distractions

During daytime activities, your brain processes multiple inputs—work, conversations, tasks. At night, with fewer distractions, your nervous system can focus more acutely on pain signals. Research suggests sleep hormones may also heighten your perception of discomfort.

Teeth Grinding (Bruxism)

Many people unconsciously grind their teeth whilst sleeping. This constant grinding wears away protective enamel and can trigger or worsen existing tooth pain. If you wake with jaw stiffness alongside toothache, bruxism may be contributing.

Sinus Pressure

If your toothache affects upper back teeth, sinus congestion may be involved. When lying down, sinus pressure builds and can radiate into your teeth, causing or worsening dental pain.

Common Causes of Toothache

According to NHS guidance, toothache can result from:

Dental pain accounts for over 70% of out-of-hours emergency dental appointments, according to the British Dental Journal.

Safe Pain Relief for Toothache at Night

The NHS recommends several approaches for managing tooth pain whilst waiting for a dental appointment.

Recommended Painkillers

Ibuprofen is particularly effective for toothache because it's anti-inflammatory—it doesn't just mask pain but actively reduces the swelling often causing it.

Paracetamol can be used alongside or instead of ibuprofen.

"For severe pain of dental origin in adults, either ibuprofen and paracetamol alternately (e.g. ibuprofen 400mg followed 2 hours later by paracetamol 2 x 500mg) without exceeding recommended doses." — NHS England Clinical Guidance

Important: Children under 16 should not take aspirin. Always check with a pharmacist if you take other medications or have health conditions.

Salt Water Rinse

The NHS recommends rinsing with salt water (adults only—children may accidentally swallow it):

1. Dissolve one teaspoon of salt in a glass of warm water
2. Swish around your mouth for 30 seconds
3. Spit out—do not swallow
4. Repeat up to three times daily

Salt water acts as a natural disinfectant and reduces inflammation.

Other NHS-Approved Self-Care

• Use pain-relieving dental gel (available from pharmacies)
• Eat soft foods like yoghurt or scrambled eggs
• Avoid chewing on the affected side
• Use a soft toothbrush
• Avoid very hot, very cold, or sweet foods

What NOT to Do

Never place aspirin directly on your gums. This is a dangerous myth. Aspirin is acetylsalicylic acid—direct contact causes chemical burns to soft tissue.

"Placing aspirin next to the tooth may leave you with a white chemical burn on the gums and cheek. Aspirin can only work when it enters the bloodstream." — Saudi Endodontic Journal

Also avoid:

• Smoking (worsens dental problems)
• Ignoring persistent pain (could indicate serious infection)

When Toothache Is a Dental Emergency

Go to A&E Immediately (Call 999) If:

• Swelling around your eye or neck
• Swelling making it difficult to breathe, swallow, or speak
• Facial swelling preventing you from opening your mouth more than two finger-widths
• Temperature above 39.5°C with lethargy and rapid heartbeat

These symptoms may indicate a spreading infection requiring immediate hospital treatment.

"Dental abscesses can lead to sepsis, a potentially life-threatening condition. Dental sepsis can have a range of local and systemic life-threatening consequences." — British Dental Journal

Seek Urgent Dental Care (Within 24 Hours) If:

• Severe pain not controlled by ibuprofen and paracetamol
• Swelling or infection spreading (with swollen lymph nodes but no breathing difficulty)
• A knocked-out permanent tooth (must be reimplanted within 60 minutes)
• Significant dental injury

See a Dentist Soon (Routine) If Toothache:

• Lasts more than 2 days
• Doesn't improve with painkillers
• Comes with high temperature, pain when biting, red gums, or bad taste
• Involves cheek or jaw swelling (not affecting breathing)

How to Access Emergency Dental Care

NHS 111

If you need urgent dental care, contact NHS 111 by phone or online. The dental triage service operates 24 hours a day, 7 days a week.

NHS 111 will:

• Assess your symptoms
• Provide self-care advice if appropriate
• Arrange an urgent appointment if you meet criteria (typically within 24 hours to 7 days)

"You must not be denied access to an available unscheduled dental care appointment where you do not have an NHS number, GP registration or current permanent address." — NHS England

NHS Emergency Dental Treatment Cost

You may be eligible for free NHS dental treatment if you receive certain benefits, are pregnant, have had a baby in the last 12 months, or are under 18 (under 25 if in full-time education). Check the NHSBSA website for full eligibility criteria.

Regional Variations

• Wales: Emergency appointments available through NHS 111 Wales
• Scotland: Contact NHS 24 (111) or use the NHS Inform dental service finder
• Northern Ireland: Contact your local health and social care trust or call 0300 123 3318

Private Emergency Dentist Costs

If you can't access NHS care or prefer private treatment, expect to pay:

Prices vary significantly by location—London and the South East typically charge at the higher end. Most UK practices have increased prices by 5–10% year-on-year due to rising costs.

The NHS Dental Access Context

Finding NHS dental care remains challenging for many patients. The British Dental Association reports that nearly 97% of adults who didn't already have a dentist couldn't access NHS care in 2024.

The government has announced 700,000 additional urgent dental appointments for 2025/26, with NHS dental contract reforms taking effect from April 2026. However, access challenges persist.

If you can't find an NHS dentist accepting new patients:

• Use NHS 111 for urgent problems
• Consider private dentists (many offer payment plans)
• Check if you're eligible for community dental services

How to Prevent Toothache

Following official Government oral health guidance:

Brushing

• Brush all tooth surfaces at least twice daily
• Brush last thing at night and at one other time
• Spend approximately 2 minutes brushing
• Use fluoride toothpaste (1,350–1,500ppm for adults)
• Spit, don't rinse—rinsing washes away protective fluoride

Fluoride Toothpaste

Interdental Cleaning

Clean between teeth daily using interdental brushes (more effective than floss) or floss if gaps are too small for brushes.

Diet

• Reduce sugary foods and drinks
• Avoid sugar before bedtime—your mouth produces less protective saliva at night
• Limit acidic drinks that erode enamel

Regular Check-Ups

See a dentist regularly for check-ups, even when you have no pain. Early detection prevents the problems that cause toothache.

Knocked-Out Tooth: Critical Steps

If a permanent tooth is knocked out, act fast—the tooth should be reimplanted within 60 minutes for the best chance of success:

1. Pick up by the crown (white part)—never touch the root
2. Rinse gently with water or milk if dirty (don't scrub)
3. Try to reimplant by placing root-first into the socket
4. Bite on clean cloth to hold in place
5. If you can't reimplant, store in milk (not water)
6. Seek immediate dental care

Frequently Asked Questions

Why is my toothache unbearable at night?

Lying down increases blood flow to your head, raising pressure around inflamed teeth. Combined with reduced distractions and lower saliva production, this makes pain feel more intense at night.

What is the best painkiller for toothache?

NHS guidance recommends ibuprofen as particularly effective because it reduces inflammation. You can alternate ibuprofen with paracetamol every 2 hours for severe pain—always follow dosage instructions.

Can I go to A&E for toothache?

A&E is appropriate only if you have signs of spreading infection: swelling affecting breathing or swallowing, swelling around your eye or neck, or very high temperature with rapid heartbeat. For severe but non-life-threatening toothache, contact NHS 111.

How can I sleep with severe toothache?

Take recommended painkillers before bed. Prop yourself up with pillows to reduce blood pressure to your head. Avoid eating or drinking anything very hot, cold, or sweet before bed. Use a salt water rinse before sleeping.

Is toothache at night a sign of infection?

Not always—nighttime toothache can result from various causes including decay, sensitivity, or grinding. However, throbbing pain that doesn't respond to painkillers, swelling, fever, or bad taste in your mouth may indicate infection requiring prompt treatment.

How much does an emergency dentist cost?

NHS emergency treatment costs £27.40 (free if you're exempt). Private emergency appointments typically cost £80–£200 for consultation, rising to £150–£500 for out-of-hours care. Treatment costs are additional.

Getting Help

If you're experiencing toothache tonight:

1. Try safe pain relief (ibuprofen, paracetamol, salt water rinse)
2. Avoid aspirin on gums, very hot/cold foods, and smoking
3. Contact NHS 111 if pain is severe or you notice warning signs
4. Go to A&E only if you have breathing difficulty, severe swelling, or signs of serious infection

Most toothaches, whilst painful, can wait until you can see a dentist during normal hours. However, don't ignore persistent symptoms—dental infections can become serious if left untreated.

Find an emergency dentist near you or call NHS 111 for dental triage.