What can I do about severe toothache at night?

Severe toothache at night usually means you need to see a dentist soon, even if it is not a true emergency. While you wait, over-the-counter pain relief, gentle rinsing, and sitting propped up rather than lying flat can help. Go to a hospital emergency unit instead if your face is swollen or you struggle to breathe or swallow.

In short

• Rinse gently with warm water and use dental floss to clear any trapped food, which sometimes eases the pain.
• Lying propped up on pillows rather than flat, and holding cooled water or a cold compress near the tooth, can help some types of toothache.
• Over-the-counter pain relief can help. Always follow the instructions on the packet and ask a pharmacist if you are unsure.
• Never place a painkiller such as aspirin directly against the tooth or gum.
• Facial swelling, or difficulty breathing or swallowing, means a hospital emergency unit, not a dentist, even at night.

This article is part of the dental emergency guidance on this site for patients in Cape Town.

What can I try at home tonight?

Rinse your mouth with warm water and gently use dental floss to clear away any food caught between your teeth, which is sometimes enough to ease sharp pain on its own. Avoid very hot, very cold or sweet food and drink, since these can trigger or worsen the pain. Holding cooled water or a cold compress near the tooth can help with some types of dental pain, and lying propped up on pillows rather than flat sometimes eases it further, since pain from the mouth and teeth can feel worse lying down. A warm salt water rinse is soothing for some adults, although it is not suitable for young children.

What about pain relief?

Over-the-counter pain relief such as paracetamol or ibuprofen can help with toothache. Always follow the instructions on the packet, and ask a pharmacist if you are not sure what is right for you or whether it is safe to take alongside any other medicine. Never place a painkiller such as aspirin directly against the tooth or gum. It does not relieve the pain this way and can burn the gum tissue.

Is it safe to wait until morning?

Pain that is mild and easing with pain relief can usually wait until your dentist’s rooms open. Pain that is severe, keeps you awake, does not ease with ordinary pain relief, or comes with a raised temperature, pain when you bite, red or swollen gums, a bad taste, or swelling of the cheek or jaw, is a sign to call a dentist as soon as you can. Outside normal hours, this site shows the number to call. See How do I find a dentist after hours in Cape Town? for how that generally works. If in doubt, call and describe what you feel rather than waiting to see if it passes.

When should I go to a hospital emergency unit instead of a dentist?

Go to a hospital emergency unit, not a dentist, if the swelling around a painful tooth is spreading towards your eye or your neck, if you are finding it difficult to breathe, swallow or speak, if you have bleeding from the mouth that will not stop, or if there has been an injury to the head. These signs mean the problem has become a medical emergency, not only a dental one, and they need urgent attention regardless of the time of night. Call an ambulance or have someone drive you there without delay. For more detail, see My face is swollen from a tooth. When is that urgent?

How do I reach Dr Davies?

At night, on a Saturday or over a weekend, call Dr Davies on her own mobile. On weekdays from 8:30 to 17:00, call the practice and ask for the next available appointment with her. This page always shows the right number for the time of day. This page gives general information about managing toothache and does not replace an examination, since only a dentist can find and treat the actual cause of the pain.