If you're having extreme tooth pain and can't sleep, there are home remedies you can try such as taking systemic painkillers & etc to get some relief. However, these will only temporarily reduce the intensity and it will not permanently get rid of the pain. You must see a dentist the next morning.
How to sleep with unbearable tooth pain:
Note: These home remedies are not a replacement for seeing a dentist. Their purpose is to temporarily dampen the toothache so that you can get some sleep. That way you won't look so haggard when you see your dentist the next day.
Take systemic painkillers
The best OTC pain reliever for severe tooth pain is Advil Dual Action because it uses acetaminophen mixed with ibuprofen. Studies have shown that the combination of ibuprofen and acetaminophen can be comparable to taking opioids.
Benefits of advil dual action:
Contains two painkillers, acetaminophen & ibuprofen in a single pill.
Those two medications work synergistically via different pain blocking mechanisms.
Pain relief comes systemically and is delivered via blood stream.
End result is a greater reduction in tooth pain.
If the painkiller you were taking wasn't working for your toothache, chances are you were probably taking them individually. When combined together, the pain relief is much greater.
The table below showed that 400 mg of ibuprofen taken with 1000 mg of acetaminophen was superior to taking them alone or even in combination with codeine.
Another study showed that the effects of that combination was equivalent to traditional narcotics such as oxycodone (percocet) and hydrocodone (vicodin). What this means is that it is a highly effective pain reliever when taken together.
Note: 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 topical analgesics
For a bad toothache, just taking systemic painkillers won't be enough. You need to block the pain from all angles and that includes alleviating it topically with an analgesic.
Common topical analgesics for toothaches:
Orajel. We recommend using the Orajel 4x since it is the most powerful version of it.
Anbesol. Interestingly, anbesol does not come in any other product variation so you don't have a choice for this one!
Both will work because they both contain 20% benzocaine which is similar to what your dentist uses. However, if you were to ask us to compare them, the Orajel 4x would be more effective in our opinion. It contains more analgesics than anbesol.
Home remedies
Not all toothache home remedies have an analgesic property to them but some do.
Essential oils. Clove oil, tea tree oil, oregano oil, basil oil, peppermint oil, etc.
Willow bark. Contains salicin which is essentially aspirin (acetylsalicylic acid).
Toothache plant. Blocks A-delta mechanonociceptors with mouth numbing effect.
You may give these a try but please stay away from the dangerous purported remedies like bleach, gasoline, and brake fluid. Those will cause you more pain than alleviate them.
Salt water rinsing
Frequent rinsing with salt water can help minimize pain from an aching tooth.
Cleanses the mouth by washing away plaque, bacteria, and food debris.
Rebalances mouth pH by neutralizing acids in which bacteria thrive.
Antiseptic and helps reduce inflammation.
Often overlooked but its oral pH regulating ability can do wonders to control bacterial activity. Microbes work most effectively in low pH environments and and less so in neutral pH.
Keep your mouth clean
The classic way to control the oral environment is to simply brush and floss. The effects and benefits parallel rinsing your mouth with salt water. Try to use a toothpaste meant specifically for sensitive teeth, which we'll explain why below.
Desensitize the teeth
After you finish brushing your teeth, you should desensitize that aching tooth with sensitive toothpaste. Yes, with toothpaste but we bet you didn't know that it can be used this way.
How to desensitize teeth with sensitive toothpaste:
Apply sensitive toothpaste to the affected tooth.
Rub it around the entire tooth and the gums.
Let it sit for 10-15 minutes.
Rinse out and repeat after every meal.
This is a well kept secret that dentists use to desensitize teeth with pulpitis from professional teeth whitening sensitivity. Inflamed tooth nerves can be calmed down by desensitizing it.
Apply cold compress
Applying a cold compress to the affected side of your face can help decrease the unbearable tooth pain. The cold will numb the area by giving a cooling sensation. The pressure applied to the face can also help keep the swelling under control.
How to use cold compress for toothache:
Place compress on affected side of face.
Hold for 15 minutes.
Remove for 15 minutes to give your face a break.
Repeat steps 1-3 as needed.
Make sure to alternate the cold compress on and off, to prevent frostbite on your face.
Avoid triggers
It is important to do things that don't make your toothache worse. First, identify what triggers your pain and then avoid them at all costs.
If eating sweet or acidic food makes the pain worse, then you need to stop doing it!
If chewing on that side hurts, try to chew more on the opposite side!
If toothache worsens while sleeping on one side, you should sleep the other way.
Makes sense right? Don't intentionally trigger the pain!
Sleep elevated
If you're having a hard time sleeping, try placing an extra pillow underneath your head. When you're having an unbearable toothache, lying flat can cause the blood to rush to the head and mouth, which makes the pain worse.
If you sleep with your head elevated, it reduces the amount of blood rushing there. The result is less pressure and thus less pain. This may just help you get some sleep despite the aching tooth.
Call a dentist
If your tooth is hurting in the middle of the night, chances are there isn't a single dentist open. However, what you can do is prepare yourself for the morning by coming up with a list of dentists to call as soon as 8am or 9am rolls round.
We recommend googling at least 10 different dentists that can potentially see you. Write down their information such as email and phone numbers. This way you'll be ready to call.
Our recommendation is to come up with at least 10 different offices because you need to be seen TODAY. There is a chance that some of them may be fully booked already and won't be able to accomodate you.
You will search for at least ten dentists and hopefully at least one of them will have an opening for today to see you. After all, if you're having a raging toothache, it NEEDS to be taken care of today.
Causes of extreme tooth pain that keep you awake
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.
Large cavity
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.
Nerve Infection
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.
Tooth abscess
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.
Fractured tooth
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.
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. Once the nerve is gone you won't feel anymore pain. In other words, you'll be able to get some sleep immediately after killing the nerve.
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 or at least minimize their occurrence.
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. It would be in your best interest to treat small problems as soon as possible so that they don't become a big problem like a raging toothache where you can't sleep.
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.
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.
Toothache tips aren't helping
Hopefully using all of the tips above would give you some relief from an extreme toothache but there is a chance it may not. If your condition is just too severe, all types of home treatment will not work.
If you're not getting any relief at all and you can't bear that toothache any longer, you may not have any other choice but to go to the emergency department (ED).
What the ED can do for you:
Give you stronger painkillers.
Rule out other causes of your pain.
What the ED can't do for you:
Unfortunately, the vast majority of emergency departments at hospitals are not equipped to perform dental procedures.
That means if you need a tooth extracted, that won't happen in the ED.
Have you ever seen a dental chair in there? You haven't because it's not equipped.
Ultimately, you'll have to wait until the sun rises and then they can refer you to their dental department within the hospital.
Due to the fact that there will be no midnight dental treatments such as root canals and extractions, the hospital visit may not be as pain relieving as you may have initially hoped. That is why we presented a lot of at home tips for you so that hopefully you can bear it through the morning to see a dentist.
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.
