It’s the middle of the night, the house has gone quiet, and the one thing in the whole world that refuses to go quiet with it is a single tooth. Here’s the surprisingly simple reason teeth save their worst for bedtime, what genuinely helps between now and morning, and the phone call after breakfast that brings it to an end.
Why does toothache get worse at night, and worse again when you lie down?
You’d be forgiven for thinking the tooth is doing it on purpose. It isn’t, and the real reason is rather fascinating once you see it.
Inside every tooth, under the hard white outside, there’s a soft living core called the pulp. NHS inform, Scotland’s national health information service, describes the pulp as “made up of sensitive nerves and blood vessels”, and says toothache happens when it “becomes inflamed.” Now, when anything in your body is inflamed, it swells a little, because extra blood rushes in to help. A sprained ankle can puff right up, because skin stretches. Enamel doesn’t. The pulp is sealed inside walls of enamel and dentine that can’t give a millimetre, so the swelling has nowhere to go, and it presses on the nerve instead.
Think of a ring on a swollen finger. The finger wants to swell, the ring won’t let it, and so the finger throbs. Your tooth is a finger that is all ring.
So here’s where bedtime comes in. All day you’re upright, which means your heart is pumping blood uphill to reach your head. Lie down and the hill disappears. A little more blood reaches your head with every beat, and a little more of it pushes into that sealed space. That extra pressure is what the nerve feels. NHS inform puts the bedtime part in one plain sentence: “It can be worse at night, particularly when you’re lying down.”
Then there’s the second reason, and it’s as much about you as it is about the tooth. During the day your brain has a hundred things to listen to: the radio, the kettle, your work, the person telling you about their weekend. At night all of that goes, and the tooth is the only thing left talking. You know how a clock ticks all day long, and yet you only ever hear it at night, once the house is still? Curious, isn’t it? Nothing about the clock has changed. Only the room has.
What does a throbbing toothache actually mean?
Well, it means the nerve in the middle of the tooth is inflamed, and something has inflamed it. The something varies. NHS inform says toothache is “usually caused by tooth decay”, and nhs.uk’s toothache page lists the other usual suspects, among them “a cracked or damaged tooth”, “a loose or broken filling” and “a dental abscess”.
Decay is the quiet one. A small hole works its way inward without making a sound, and the first you hear of it is the night it gets close enough to the nerve to complain. A crack is sneakier still, and why a cracked tooth hurts most when you let go of a bite is a story all of its own.
If the throbbing comes with a swelling in your gum, here’s a kind surprise: an abscess is treated at the tooth, by a dentist, and antibiotics are prescribed only when they’re the right treatment, which for tooth pain is less often than people expect. There’s more on that in what fixes a tooth abscess, and where antibiotics fit.
Whichever it turns out to be, the throb is simply the tooth asking to be looked at, and every one of those causes is everyday work for a dentist.
What can I do for toothache tonight?
Here’s what nhs.uk itself recommends while you wait for an appointment, and nearly all of it is something you can do from where you are right now.
Its list starts with painkillers. The advice is to “take painkillers, like ibuprofen or paracetamol”, with the reminder that “children under 16 should not take aspirin”, and that “a pharmacist can advise you”. How much to take, and how often, is the packet’s job, and nhs.uk’s own pages on paracetamol and on ibuprofen both carry the same line: “Always check the packet or leaflet that comes with your medicine.” If the cupboard turns out to be bare tonight, a pharmacist is a very good person to see in the morning.
Then come the gentle things. The page suggests you “use a pain-relieving gel for your mouth”, which “can be bought from pharmacies or supermarkets”, and that you “try rinsing your mouth with salt water”. The recipe is as simple as it gets: “Dissolve half a teaspoon of salt in a glass of warm water”, rinse, then spit it out, and “do not swallow it”. You can “Repeat as often as you like”. It isn’t one for children, though, “in case they swallow it.”
For tomorrow’s breakfast, the advice is to “eat soft foods, like yoghurt or scrambled eggs, and try to avoid chewing with the sore tooth”, and to “use a soft toothbrush and avoid flossing around the sore tooth”. And there are two things to skip: foods “that are sweet, very hot or very cold”, and smoking, because “it can make some dental problems worse”.
There’s one more that isn’t on nhs.uk’s list, and it follows straight from everything above. Since lying flat is half the trouble, an extra pillow, so your head sits a little higher than usual, can take some of the edge off the throb.
None of this treats the tooth, and it doesn’t need to. Its whole job is to carry you comfortably to the morning, when a dentist can treat the cause.
Will the pain stop on its own if the nerve dies?
Sometimes it does, and this is the part people are rarely told straight. An inflamed nerve can calm back down. It can also die, if it has been inflamed for long enough. Either way, the pain can simply stop. Nobody can tell you a number of days for that, because every tooth is different, and it’s a poor thing to wait for anyway. Here’s why.
The nerve, you see, is only the messenger. Whatever upset it in the first place, the decay or the crack or the tired old filling, is still sitting in the tooth after the messenger has gone quiet. So a tooth that stops hurting still wants seeing.
The good news is that having it seen is a calm, ordinary visit. Clearing out a nerve that has died is exactly what a root canal does, and the tooth stays. At Designer Smiles a root canal is £550 for a front tooth and £850 for a molar. The gap is simply the extra canals a molar has to clean.
How do I get seen in the morning, and what does it cost?
This is where the night ends. Ring us on 0121 709 3821 as early in the day as you can. In practice hours (Monday to Friday, 9am to 5pm) we set out to see anyone with a dental emergency the same day, and the earlier you ring, the sooner the slot. You don’t need to be a patient of ours already. If you’d rather sort it from your pillow, our booking page is online at any hour, and you can message us on WhatsApp too.
In those hours the emergency appointment is £27.90, the same figure as the NHS urgent charge, and it covers the examination and getting you out of pain. The tooth is numbed first, and then it’s made safe. Toothache from the nerve is settled by dressing or removing it, which is the first stage of a root canal and costs £76.60. Anything else the tooth needs is priced from our fee guide and told to you before it’s done, so nothing lands on the bill you didn’t agree to.
You’ll see whichever of our dentists is free first, and all of them do the whole of general dentistry, so the person who gets you out of pain is the person who plans the repair. It’s planned and priced once the pain has gone, and booked for another day, usually within the fortnight. Payment is on the day, and there’s 0% finance through Tabeo for the larger repairs. How the same-day emergency appointment runs, step by step is set out on our emergency page.
If you’d like every figure laid out side by side, what an emergency visit and the treatment after it cost goes through them, and how to be seen today in Solihull covers every route, the NHS one included.
What if it can’t wait until morning?
Usually it can, and everything above is there to help you get there. If it’s a Friday night or the weekend, the morning call is a little further off, and the evening and weekend options in Solihull are set out on their own page. The advice on nhs.uk, if you can’t get an emergency appointment, is to “call 111 or visit 111 online”, where “they can advise you what to do”.
And for the rare night when your face is swelling so much that it’s affecting your breathing, your swallowing or an eye, that’s A&E or 999 rather than a dentist in the morning. When a hospital is the right place for a tooth is a read of its own.
So, for the rest of tonight: painkillers the way the packet says, a warm salt water rinse, and that extra pillow. The tooth is louder in bed because a swollen nerve has no room and the house has gone quiet; that’s simply how teeth behave at night. Then ring 0121 709 3821 when the practice opens, and the visit that gets you out of pain is £27.90.
