Toothache often seems to get worse at night. Lying flat, being tired and having nothing else to think about can all make the same pain feel stronger. Here is what you can safely do until you can see a dentist, and the signs that mean you should not wait.

First, check for danger signs

Go to the nearest hospital emergency department now, or call 112 (ambulance in Uttar Pradesh: 108), if there is:

  • swelling of the face, jaw or neck that is spreading, or that makes it hard to breathe, swallow, speak or open the mouth;
  • swelling around the eye, or sudden problems with eyesight;
  • high fever with a swollen face, or the person seems very unwell.

These can be signs of a spreading infection, which needs hospital care.

What helps until morning

  • Take a painkiller such as paracetamol or ibuprofen, following the dose on the pack and never more. Children under 16 should not take aspirin. If you are pregnant, have other illnesses or take other medicines, ask a pharmacist first.
  • Rinse with warm salt water: half a teaspoon of salt in a glass of warm water, rinse, then spit it out. Young children should not do this, in case they swallow it.
  • Keep your head raised with an extra pillow.
  • Clean gently around the tooth with a soft toothbrush. Avoid flossing around the sore tooth.
  • Avoid very hot, very cold and sweet food and drinks, and chew on the other side.
  • Hold a cold pack wrapped in a cloth against the cheek, 15 minutes at a time, if there is swelling.

What not to do

  • Do not put a painkiller tablet on the gum or the tooth. It can burn the gum.
  • Do not take more than the recommended dose of any painkiller. A higher dose does not work better and can be dangerous.
  • Do not take leftover antibiotics or antibiotics without a prescription. Toothache from decay needs dental treatment, not only medicine.
  • Do not apply heat to a swollen face, and do not try to burst a swelling on the gum.
  • Do not smoke or chew tobacco; it can make some dental problems worse.

Why it happens

Common causes include tooth decay that has reached the nerve, a dental abscess, a cracked tooth or a broken filling, a wisdom tooth that is coming through, and gum problems. Pain that lingers after hot or cold, or that wakes you at night, often means the pulp inside the tooth is inflamed. That usually needs root canal treatment or removal of the tooth, not just a filling.

See a dentist soon

The NHS advises seeing a dentist if toothache lasts more than two days, does not go away with painkillers, or comes with a high temperature, pain when biting, red gums, a bad taste or a swollen cheek. A dentist can find the cause and treat it before it gets worse.

When you message the clinic, your question and the day you would like to come are enough for the first message. If you are in Nautanwa, Sonauli or across the border in Nepal, the dental pain page has first aid for other problems, such as a knocked-out tooth or bleeding after an extraction.

This article is general information, not a diagnosis. If you are worried about someone’s health, get medical help.

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