What helps a toothache tonight is over-the-counter pain relief taken correctly, keeping your head elevated, a cold compress on the outside of the cheek, and avoiding hot food and drink. What makes it worse is heat on the face, aspirin held against the gum, leftover antibiotics, and clove oil applied repeatedly. None of these treat the cause — they get you to morning.
If you are in pain now, every call from someone in pain is treated as urgent.
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First: the signs that cannot wait
Go to a hospital emergency department, or call 000, if there is:
- Swelling that is spreading, particularly towards the eye or down the neck
- Difficulty swallowing, or difficulty opening the mouth
- Any difficulty breathing
- Fever together with facial swelling, or feeling generally very unwell
- Swelling in the floor of the mouth or under the tongue
- Uncontrolled bleeding, or a facial injury involving the jaw
These indicate infection or injury extending beyond the tooth, and they are hospital matters rather than things to manage overnight. It is uncommon, but it is the reason the list comes first.
What actually helps overnight
Pain relief, taken properly
The most common mistake is not the choice of medication but the timing. Waiting until the pain is severe and then taking a single dose works far less well than taking it at regular intervals according to the packet.
Paracetamol and ibuprofen work through different mechanisms and are often more effective together than either alone, where both are suitable for you. Ibuprofen is not appropriate for everyone — people with stomach ulcers, kidney problems, asthma triggered by anti-inflammatories, some heart conditions, or who are pregnant should not take it without advice. A pharmacist can tell you what is appropriate in a couple of minutes, and pharmacies are open late in most areas.
Do not exceed the dose on the packet. Dental pain that needs more than the maximum dose is telling you something that dosing cannot solve.
Keep your head up
Lying flat increases blood pressure in the head, which increases pressure inside an inflamed tooth. This is precisely why toothache is worse at night, and why so many people are awake at 2am with it. Sleeping propped on an extra pillow or two genuinely reduces the throbbing.
Cold, on the outside
A cold pack or a wrapped bag of frozen peas against the cheek for 15 to 20 minutes at a time reduces swelling and dulls the pain. Wrap it — nothing frozen directly against skin.
Rinse gently with warm salty water
Half a teaspoon of salt in a cup of warm water. It will not treat an infection, but it cleans debris from the area and often makes it feel better.
Avoid what triggers it
Chew on the other side. Skip very hot and very cold food and drink. Skip sugar. If a specific temperature sets it off, that is diagnostic information worth remembering, not something to keep testing.
Temporary filling material
If a filling has come out and the cavity is sharp or food-trapping, a pharmacy temporary filling material can cover it until you are seen. It is a dressing, not a repair, and it does not remove the need for an appointment.
Emergency appointments are generally available in the afternoons — call in the morning and we will find you a spot.
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What to stop doing
Holding aspirin against the gum
A persistent piece of folk advice that causes a chemical burn on the gum tissue. Aspirin works by being absorbed, not by contact. You end up with a toothache and an ulcer.
Heat on the face
A hot pack against a swollen cheek feels soothing and encourages a bacterial infection to spread through the soft tissue. Cold, not heat, when there is any swelling.
Leftover antibiotics
An old part-course from a previous problem will not resolve this one. Antibiotics do not remove the source of a dental infection — they buy time at best — and taking incomplete courses contributes to antibiotic resistance. Whether antibiotics are appropriate at all depends on the diagnosis.
Clove oil, repeatedly
Eugenol in clove oil does have a genuine numbing effect, which is why the remedy persists. Applied repeatedly to gum tissue it also irritates and can burn it. Occasional use on the tooth itself is unlikely to do harm; soaking cotton wool and leaving it in place is not a good idea.
Alcohol
Does not numb a tooth, interacts with pain medication, and disrupts the sleep you are trying to get.
Trying to burst a swelling
Never. It spreads infection into tissue rather than releasing it.
What is likely causing it?
The pattern of the pain narrows it down considerably, and it is worth noting so you can describe it:
- Brief sharp pain on cold or sweet, gone immediately: commonly a cavity into dentine, exposed root surface, or a worn area. See what happens before a cavity causes pain.
- Sharp pain on releasing a bite: often a cracked tooth. See why a cracked tooth hurts when you bite.
- Lingering pain after hot or cold, or spontaneous throbbing that wakes you: suggests the nerve is inflamed. Root canal treatment or extraction is usually the conversation.
- Constant pain, tender to touch, tooth feels raised, swelling or a lump on the gum: suggests infection at the root or in the gum — see the warning signs of a dental abscess.
- Dull ache across several upper teeth with a blocked nose: sinus pressure can mimic toothache, and it is worth mentioning if you have a cold.
One thing worth knowing before morning: if the pain stops on its own overnight, that is not necessarily good news. An abscess that drains releases pressure and the pain can disappear entirely while the infection continues. Book anyway.
What happens at the appointment?
An emergency consultation at Berala Dental includes any X-rays clinically required within the consultation fee. The focus is establishing the cause and relieving the pain; definitive treatment is discussed with a written quote before anything begins. All figures assume no health fund contribution, and your fund may contribute depending on your policy.
For after-hours health advice, Healthdirect Australia is available on 1800 022 222.
Quick answers
Why is toothache always worse at night?
Lying flat raises blood pressure in the head and therefore pressure inside an inflamed tooth. There are also fewer distractions. Sleeping propped up on extra pillows genuinely helps.
What is the strongest thing I can take for toothache at home?
Paracetamol and ibuprofen taken together at packet doses, where both are suitable for you, is generally more effective than either alone. A pharmacist can confirm what is appropriate given your medical history and other medications.
Should I put a heat pack on a swollen face?
No. Heat can encourage a bacterial infection to spread through soft tissue. Use a wrapped cold pack instead, and seek assessment promptly if the face is swollen.
My toothache stopped on its own. Do I still need to go?
Yes. Pain stopping often means the nerve has died or an abscess has drained, both of which leave the underlying problem in place. It is a change in symptoms, not a resolution.
In the morning
Everything above is designed to get you through the night. None of it treats the cause, and the cause is what determines whether this is a filling or something larger.
Berala Dental has looked after Berala families since 2002, and no question is a silly one.
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You can also read about emergency dental care, what to do with tooth pain at 2am, whether to see a dentist or a GP, or how our fees work.
Written and reviewed by Humzah Aly, Oral Health Therapist. This article is general information only and is not a substitute for personalised dental advice. Please see a dental practitioner to discuss what is right for you.
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