Why Do My Teeth Hurt When I Wake Up?

You must think that you have a unique situation because your teeth only hurt when you wake up in the morning. They don't hurt throughout the day at all and will only bother you after you wake up.


It is actually much more common than you think but the primary reason as to why you've pain upon waking has more to do with your nighttime habits. They're usually related to your TMJ (temporomandibular joint) and various TMJ disorders.


Aside from that, there are also a whole host of other dental conditions which may cause your teeth to hurt. However, they would cause you pain at all times of the day and not JUST when you wake up. Some people confuse these conditions as being a culprit for your morning dilemma.


This article will go over all of the actual causes of what makes your teeth hurt only when you wake up. We'll also debunk all of the false claims about certain dental conditions which may be culprits.



Table of Contents:



Reasons why your teeth hurt only when you wake up in the morning

If your teeth hurt only when you wake up and at no other time in the day, it definitely has something to do with what you're doing in the middle of the night. You must have some sort of TMJ disorder, teeth grinding, or clenching while you sleep. You're doing something with your jaw while you're sleeping and inflicting pain upon your teeth. That can be the only explanation for your teeth pain upon waking.



TMJ disorders

Having TMJ problems such as a deteriorating disc can certainly contribute to the pain that you feel in the morning. Overuse of the disc in your temporomandibular joint will lead to deterioration. Once it does, even mild grinding or clenching of the teeth during your sleep can aggravate it.


dysfunctional TMJ

The TMJ gets used whenever you open and close your mouth. This includes talking and eating. It may not be an issue throughout the day since you may be using it only lightly.


However, it can cause you pain in the morning if you're constantly clenching or grinding your teeth while you sleep.


Here are signs that you may have a problem with your temporomandibular joint:

  • Clicking or popping in your jaw

  • Tiredness in your jaw when eating hard foods

  • Jaw deviates to one side when you open

  • Locked jaw.


In addition to that, it is also interesting that they can refer pain to other parts of your skull, such as your face, ear, and temple of your head. The reason is because of the muscles which attach to the joint. Usually overuse of the joint also means overuse of the muscles which control it. That can cause the muscles to spasm and refer pain.


Treatment

Most treatment for it is usually palliative. They'll help alleviate some of the symptoms that you're feeling but may not completely cure the condition.

  • Night guard. You can have your dentist fabricate one for you. You wear it at night and it may help you grind or clench less. It can also position the joint in a more optimal place so that it puts less pressure on it.

  • Physical therapy. There are certain exercises which you can do, which can help with alleviating some of the pain.

  • Botox injections. Freezing some of the TMJ muscles can make you aggravate them less.

  • Lifestyle modifications. Destressing can always help you do less of the parafunctional night time activities with your teeth. Most of the time, bruxism and clenching are the result of stress during the day which gets carried over to your sleep.


Surgical treatments

Last but not least, the worst case scenario is to have a total joint replacement. This is a major surgical procedure which is done in the operating room where your old TMJ gets removed. Then it gets replaced by a titanium one and some plates to hold it in.



There is also a less invasive surgical procedure called arthrocentesis, where the TMJ gets flushed out with a sterile solution. It may reduce TMJ pain by eliminating inflammatory mediators within the joint. It'll help recover joint mobility by reducing the negative space within the joint.



Teeth grinding (bruxism)

Heavy teeth grinding in the middle of night can certainly cause you pain in the morning when you wake up. It's actually a double whammy because when you grind, you put pressure on the TMJ and you also wear through the enamel of your teeth.


Pressure on TMJ

Constant teeth grinding means constant use of the TMJ. This can lead to a lot of stress on the joint and may result in disc deterioration when this happens long term. Usually the joint will be sore as well as the TMJ muscles.


Wearing through the enamel

Bruxism can cause some serious damage to your teeth because when you grind your teeth against each other, the enamel will wear through. Once the enamel is gone you'll be left with the dentin layer which is filled with nerves.


This means that your teeth will be sensitive when the dentin is exposed. In addition to that, all of that pressure on the teeth the entire night will certainly cause your teeth to either be tender or painful when you wake up.


Treatment

Teeth grinding is usually a result of stress. In other words, the only permanent cure to make you stop grinding your teeth is if you got rid of whatever it was that was stressing you out. Since the source of stress for most people are from relationship issues or their job, it is difficult to get rid of them.


Recommendations for managing bruxism:

  • Night guard. Have your dentist make one for you so that you can at least prevent your teeth from becoming damaged. You'll grind on the guard instead of your own teeth.

  • De-stressing. Pick up activities that help you de-stress such as yoga or meditation.

  • Self myofascial massage. Long term bruxism can cause muscle knots in the TMJ muscles. These knots can cause the muscles to spasm, which will cause you jaw pain in the morning. It becomes a positive re-enforcing cycle of pain in the morning.



Teeth clenching

If you clench your teeth, the causes are very similar to teeth grinding. The only exception is that for clenching, you don't do as much damage to your enamel. Since you're just clenching your teeth together and grinding them side to side, the enamel tends to not wear down as much.


Symptoms and signs:

  • Jaw and TMJ pressure

  • Sore and tender jaw when you wake up

  • Tired or painful TMJ muscles

  • May develop abfractions near the gumline


abfractions and recession near gumline of canine

The teeth clenching can cause abfractions to form or recession near the gumline of your teeth. They basically feel like little notches if you run your fingernail over them. The reason these form is because when you clench, the teeth actually flex. It is near the gumline where the stress breaking point is.


Treatment

Since this condition is usually induced by stress the only way to stop doing it is by getting rid of the source of stress.

  • Night guard. Make a guard to wear at night. It may make you clench less.

  • De-stress. Try to pick up activities that help you de-stress, it can be anything that helps you. Either that or try to get rid of things that bring you stress.

  • TMJ muscle massage. See a massage therapist or physical therapist and have them work out the muscle knots in those TMJ muscles.




Alleged dental conditions that don't only hurt your teeth when you wake up

When we talk about having teeth pain when you wake up, we mean it should only hurt in the morning. If your condition elicits pain throughout the rest of the day then it does not qualify as one that just hurts upon waking from your slumber.


Thus, that is the main criteria we use for all of the dental conditions listed below. They're all problems with your mouth or teeth that hurt you after you wake up and before you sleep. Basically they hurt you all day long and don't necessarily only do it after you wake up.



Sinusitis

Sinusitis is inflammation of the sinus and it may be caused by an infection. According to this study, here are some common causes:

  • Viral infection

  • Allergic and non-allergic rhinitis

  • Anatomical variations


If your sinus is inflamed, it would hurt you even while you're awake and not only while you're asleep. Due to this reason alone, we would have to say that it is not likely to be the cause of your jaw pain from waking up.



Tooth decay

Small cavities usually will not cause you pain but they may be mildly sensitive to sweets. Large cavities on the other hand will hurt you if they've grown large enough to affect the tooth nerve. Once the nerve is affected it will hurt you all day long.


large cavity on side of wisdom tooth

That is actually one of the criteria that we use to diagnose the nerve as irreversible pulpitis, which means non-reversible pulp inflammation. It basically means that the nerve will cause you pain sporadically and randomly throughout the day without any specific trigger. It means it will hurt you in your sleep and also while you're awake.


Due to the constant randomly throbbing pain that large cavities into the nerve can cause, we would have to say that it is not likely to be the source of your pain in the morning.



Gum disease

Gum disease such as gingivitis or periodontitis will cause gum inflammation. Unfortunately, this type of inflammation in the gums does not discriminate based on the time of the day. It will cause your gums to hurt and bleed at all times throughout the day!


bleeding gums from gingivitis

In other words, it won't hurt you just when you wake up in the morning. In fact you may notice them bleed the most after you brush or floss. That is usually a sign that you have gum disease.



Impacted tooth

If your wisdom teeth are impacted, it may cause you pain whenever the teeth start to move. This is especially the case if the tooth is sideways and pushing into the tooth in front of it. Due to its angulation, it is unable to erupt so all you'll feel is jaw pressure.


impacted lower wisdom tooth that is sideways.

This condition won't necessarily hurt you only when you wake up in the morning. It'll most likely hurt you throughout the entire day whenever the tooth tries to move. This is one of the biggest reason for emergency wisdom teeth visits at the dental office!



Tooth abscess

A severe tooth abscess will be accompanied with facial swelling. Certainly this condition will hurt you in the morning when you wake up but it'll also hurt you throughout the entire day. The reason is because the swelling doesn't just go away after you wake up. It'll persist until you finally decide to see a dentist.


dental abscess with swelling
Credit: Egoite


The only way to get rid of this type of tooth abscess is by having it drained at the dentist. In addition to draining it, you'll also need the offending tooth treated with either a root canal or extraction. The reason is because the source of the infection stems from a tooth, which is also why it is called a tooth abscess.



Takeaway

If you're having pain only when you wake up in the morning and at no other time of the day, it is definitely due to something that you're doing in your sleep. The usual culprits are from TMJ disorders, teeth grinding, and teeth clenching.


Unfortunately the source of these problems are usually due to stress so there isn't really a cure per say. The only way to permanently get rid of it is by de-stressing and getting rid of what is stressing you out.


Since that may be impossible the default treatment option your dentist will give you would be to manage the symptoms. You'll definitely get a night guard made. You can also add in some adjunctive massage therapy for the tired TMJ muscles. Last but not least, you should do your best to do activities that can help you relieve some stress!

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!