Updated: Oct 14
At least once in a lifetime, everyone will get the opportunity to experience a raging toothache that is disruptive enough to prevent you from sleeping. The severity of the pain is incomprehensible until you finally experience it.
Our dentists will tell you the best way to temporarily relieve the tooth pain so that you can finally get some sleep so that you can survive to make it to the dentist the next morning. We'll also go over all of the causes and how to prevent it from happening ever again.
Table of contents:
How bad is extreme tooth pain?
This type of tooth pain isn't your everyday type of pain that is merely mildly annoying or irritating. What we are talking about is a severe toothache that hurts so bad you can't sleep. You literally cannot ignore it nor can you even try to sleep it off because it will prevent you from sleeping. In fact, if you try to go to sleep it will wake you right back up within a couple of minutes. This toothache is so bad that everyone who experiences it will not get a wink of sleep at all.
What it'll feel like is a 10 out of 10 on the pain score scale. It could be constantly throbbing or it could come and go sporadically without anything triggering it. When the pain does come, it'll feel sharp and sudden. It won't feel feel like a dull ache because it tends to be more intense. This is an unbearable toothache and it is basically what a tooth that needs a root canal feels like.
How to relieve the pain and get some sleep
This is a temporary method that will allow you to get some sleep by minimizing the tooth pain just enough so that you won't get woken up in the middle of night. It won't completely eliminate the pain nor permanently cure it because only your dentist can do that.
Take a combination of pain medication
It is not enough to take ibuprofen or acetaminophen alone because you need to take both of them together in order it to be effective for extreme tooth pain. This study showed that when 400 mg of ibuprofen is taken together with 1000 mg of acetaminophen had a superior effect to taking either of them alone or even when they are combined with codeine.
Another study showed that the effects of that combination was equivalent to traditional narcotics such as oxycodone and hydrocodone. What this means is that it is a highly effective pain reliever when taken together.
What you should do is take 400 mg of ibuprofen and 1000 mg of acetaminophen an hour before you try to go to bed. You should be able to get some sleep once you do and when you wake up in the morning you should contact your dentist immediately. This amount of painkillers is NOT meant to be taken long term, it is only suppose to help get you through the night because your dentist is most likely not open at midnight.
Use a cold compress
Placing an ice pack on the side of your face that is in pain can help relieve some of the pressure by numbing it with the cold temporarily. The cold will also somewhat help with mildly reducing some of the potential swelling. You can use the cold compress for 15 minutes on and 15 minutes off. Repeat as many times as necessary.
Maintain good oral hygiene
Depending on what is causing the toothache, keeping your mouth and teeth as clean as possible will help reduce the amount of potential bacteria or food that may be contributing to the pain. This means that you should brush your teeth for two minutes and then flossed them. You should also use a gentle mouse rinse such as salt water because anything acidic may aggravate the pain. The acidic rinses that you should stay away from would be listerine and hydrogen peroxide.
Alternatively you can also use coconut oil for oil pulling. You would need to swish the oil around your mouth for about 15-20 minutes for it to be effective. The reason why coconut oil is gentle is because it has a neutral pH.
Elevate your head
You may have noticed that the pain feels worse when you are lying down. The reason is because when you're laying flat on your bed, blood will rush towards your head and your mouth, which creates additional pressure towards an area that is already in pain. In order to counteract this extra pressure, you should elevate your head with extra pillows so that it will decrease some of that blood flow from pooling around your head.
That helps to explain why the toothache does not feel as bad when you're standing up because gravity helps to pull the blood away from your tooth.
In addition to that, this is also one of the reasons why the pain feels worse at night. The other reason is that during the middle of the day, you're usually forced to be working so that serves as a distraction to make you not think about the pain. Unfortunately at night, there is nothing else to do but sleep so now you have your full attention and focus on the toothache.
Other home remedies that are less effective
There are other remedies, which you can try but they won't be as effective as the 4 listed above. These may alleviate the pain under normal circumstances such as mild tooth pain but for a severe one it won't help very much.
Clove oil. This oil may have anti-inflammatory and local anesthetic effects that can calm down a raging toothache. Although if you're having pain coming from the tooth nerve, the oil won't be able to penetrate through the tooth to get to it. That makes it not very effective.
Garlic. This food does indeed have antibacterial properties when consumed in a large enough quantity. It is more effective when eaten raw as well. Nonetheless, this may help for a mild toothache but not for a severe one.
Peppermint tea. Placing a tea bag over the offending tooth can sometimes offer pain relief, especially if you're having a gum issue. If you're having pain coming from the tooth, the tea may not be penetrate the enamel to calm it down.
Hydrogen peroxide rinse. If you're having severe pain in your mouth, using an acidic rinse such as hydrogen peroxide may aggravate the tooth even more. It is recommended to use a more gentle rinse. Under normal circumstances, hydrogen peroxide is effective for killing bacteria in the mouth.
What causes extreme tooth pain that can keep you up at night?
For pain that can wake you up from your sleep, it has to be a very serious dental problem because a small cavity would never have the potential to disturb your sleep. There are 4 conditions which have the possibility of causing you enough pain to keep you up at night.
Untreated tooth decay can grow into a large cavity that can affect the nerve. Once the decay penetrates the nerve, you will experience unbearable tooth pain unlike anything you've ever known. This process may take years before it happens, which is why it is important to go for your biannual dental check ups so that you can treat the cavities while they're small.
Despite the absence of tooth decay, sometimes the nerve can still get infected and become extremely inflamed. We call this condition irreversible pulpitis when the nerve of the tooth becomes so inflamed that it just spontaneously causes you pain without any stimulus triggering it. It explains why you can have pain while trying to sleep even though you're not eating or purposefully agitating the tooth.
A dental abscess can cause severe facial swelling, which can become extremely painful and difficult to ignore. In fact, the swelling can increase at an alarming rate where half of your face looks completely different from the other side. This condition is actually very dangerous and could be life threatening because a possible consequence of the swelling could cause you breathing difficulties. We would recommend that you go to the emergency department at your nearest hospital immediately.
The last thing that can keep you up at night is a fractured tooth. Imagine if your tooth was split in half, it would be painful wouldn't it? Sometimes it can be obvious where you can visually see your tooth cracked in half but other times it isn't so clear because the crack can be inside of the tooth. If that is the case you wouldn't be able to see it but you would still feel the pain coming from it.
Other conditions that may cause you mild to moderate pain
There are various other dental conditions that may cause you a mild to moderate amount of pain but they wouldn't be severe enough to prevent you from sleeping.
Sinusitis. Your sinus is very close to the roots of some of your top teeth so if it swells up you may feel like you're having a toothache.
Teeth grinding. Grinding your teeth at night time can put a lot of pressure on the tooth and its ligaments. This can cause your teeth and jaw to feel sore when you wake up in the morning. The condition is usually caused by stress and a certain subset of people take their stress out on their teeth while they're sleeping.
TMJ disorder. If you're having problems with your TMJ, you can get clicking noises when you open and close your jaw. This can also lead to clenching your teeth which also puts pressure on your mouth.
Gum recession. When your gums recede, it exposes the more sensitive part of your tooth, the root surface. It is sensitive because the gums usually cover it so it is not use to a lot of external stimulation. Since they have receded, it will become exposed and sensitive to all sorts of temperature such as cold and hot. People with this condition are usually averse to drinking cold water or iced drinks.
Late night meals. Snacking on sweet desserts in the middle of the night can aggravate existing cavities in your mouth especially if you don't brush and floss afterwards. Old dental fillings which can be leaky will also become sensitive as well. You'll notice a sharp zing once the sweet touches the filling.
These conditions aren't as serious and you most likely don't have to see your dentist the next day nor do you need to follow the pain medication protocol above. Although we do recommend that you should try to see your dentist as soon as possible because it is urgent but not emergent.
Treatment for an unbearable toothache at night
There are only two ways that your dentist can treat your extreme tooth pain and that is by performing either a root canal or tooth extraction. Both techniques will kill the tooth nerve, which is constantly sending pain signals to your brain and preventing you from sleeping.
Root canal. This procedure will remove the nerve from the tooth but leave the tooth intact. Afterwards you will need a dental crown placed over the tooth to protect it because once the nerve is removed, the blood supply is also removed along with it. Consequently the tooth will no longer receive anymore nutrients so it does become brittle and will risk fracturing if you bite into something hard. The crown is to prevent a fracture from occurring.
Tooth extraction. Removing the entire tooth will also kill the tooth nerve because the nerve comes out with the tooth. Of course this is a much more drastic treatment option when compared to the root canal since the tooth stays in the mouth for the later procedure. Afterwards you should replace the missing tooth with a dental implant.
Both treatments will kill the tooth nerve pain permanently by eliminating the nerve. If there is no more nerve then you can't feel anymore pain. In other words, you'll be able to get some sleep immediately after the nerve is gone. All home remedies are unable to do this because the nerve will stay in your tooth. This is why only your dentist can permanently cure your unbearable tooth pain.
How do I prevent it from happening again?
Once you get a severe toothache, it is already too late but the good news is that there are ways to prevent future incidents from happening.
Dental check up every 6 months. If you go in routinely for your check ups and dental cleanings, your dentist will be able to identify problems while they're still small. Small problems require simple solutions. It would be in your best interest to treat small problems as soon as possible so that they don't become big problems like a raging toothache.
Maintain impeccable oral hygiene. You only see your dentist twice a year so keeping your pearly white chompers nice and clean everyday is solely your responsibility. Only you can brush them twice a day and floss before bed so be diligent about it. You want to ward off gum disease and tooth decay.
Minimize sugar intake. Tooth decay forms when bacteria process the sugar in your mouth and create acids that cause cavities. If you simply eat less sugar and carbohydrates, the bacteria will have less fuel to work with. This helps to minimize the amount of cavities that you can get and consequently the chances of you having unbearable tooth pain.
You should know that severe tooth pain will not go away on its own but there are ways to help you get some sleep so that you can at least be more refreshed when you see your dentist in the morning. Only your dentist can permanently get rid of severe pain so do not try to put it off. Pain that prevents you from sleeping is not something that you can just bear through.
Author: This article was written by Dr David Chen, an emergency dentist in long island city.
This article is for information purposes only.
You should consult your own dentist since they are your primary care provider.
99.99% of dental symptoms require intervention by a dentist, that's just the unfortunate nature of dentistry. (Hint: its the reason why you can't get rid of us.)