Toothache at night: what to do now, and when it is an emergency
When to go to a hospital emergency department tonight
- Swelling of the face, under the jaw or around the eye that is getting bigger
- Difficulty breathing or swallowing, or you cannot open your mouth properly. Call 995 if breathing is affected
- Fever or feeling generally unwell together with dental pain or swelling
- Bleeding from the mouth that does not stop after 15 to 20 minutes of firm pressure
- A blow to the face or jaw, a suspected broken jaw, or deep cuts to the lips, gums or tongue
The National Dental Centre Singapore directs adult dental emergencies outside its clinic hours to the Singapore General Hospital emergency department, and children’s dental emergencies to KK Women’s and Children’s Hospital Children’s Emergency. Any hospital emergency department can assess a spreading infection. More in Dental emergency in Singapore: A&E, NDCS or a dentist?
What you can do tonight
- Rinse with warm salt water (about half a teaspoon of salt in a glass of warm water) and gently floss either side of the tooth. Trapped food is a common, easily fixed cause of pain.
- Rest with your head raised on an extra pillow.
- For swelling, hold a cold pack wrapped in a cloth against the cheek, 15 to 20 minutes at a time. Do not apply heat to a swelling.
- Avoid triggers: very hot, cold or sweet food and drink, and chewing on that side.
- Do not use leftover antibiotics. They do not relieve the pain of an inflamed nerve and may mask a spreading infection.
Why toothache often feels worse at night
When you lie flat, more blood flows to the head, which can raise the pressure inside an inflamed tooth, and there is less to distract you from the pain. Pain that wakes you up, or throbs on its own without any trigger, usually means the nerve inside the tooth is inflamed and needs attention soon.
What is likely causing the pain?
Only an examination, and usually an X-ray, can tell for certain. These patterns are a guide to how soon you should be seen.
| What you notice | Common causes | How soon to see a dentist |
|---|---|---|
| Sharp twinge with cold or sweet food that fades within seconds | Sensitive teeth, early decay, worn enamel or receding gums | Routine appointment. See sensitive teeth |
| Pain that lingers after hot or cold, throbs on its own, or wakes you up | Inflamed tooth nerve (pulpitis), usually from deep decay or a cracked or heavily filled tooth | Within a day or two |
| Pain on biting, the tooth feels “high”, a pimple or swelling on the gum, a bad taste | Infection at the root tip or in the gum (abscess) | Same or next day; hospital tonight if swelling is spreading or you have a fever |
| Pain and swollen gum at the very back of the mouth, difficulty opening wide | Infection around a partly erupted wisdom tooth (pericoronitis) | Same or next day. See swollen gum around a wisdom tooth |
| Sharp pain on biting or releasing on one spot | Cracked tooth | Within a few days; avoid chewing on that side |
| Ache in several upper back teeth with a blocked nose or after a cold | Sinus congestion, which can feel like toothache | See a doctor or dentist if it does not settle as the cold clears |
If the pain has stopped, do I still need to see a dentist?
Yes. Pain that stops suddenly after days of throbbing can mean the nerve inside the tooth has died. The tooth can then become infected without warning, sometimes with swelling. An X-ray will show whether treatment is needed.
What happens at the dentist the next day
Your dentist will ask about the pain, examine the tooth and take an X-ray. Depending on the cause, treatment may be a filling, root canal treatment to remove the inflamed or infected nerve and keep the tooth, draining an abscess, or removing the tooth. The options, including what happens if you wait, and the fee are explained before anything is done.
Paying for it: CHAS Blue, CHAS Orange, Merdeka Generation and Pioneer Generation cardholders receive subsidies for the consultation, X-rays, fillings, extractions and root canal treatment, within CHAS claim limits (CHAS subsidy table). Patients aged 60 and above can also use Flexi-MediSave for root canal treatment and crowns.
Frequently asked questions
Can a toothache go away on its own?
The pain can stop, but the cause usually has not gone away. A toothache from decay or an inflamed nerve may ease because the nerve inside the tooth has died; the tooth can then become infected later, sometimes with swelling. If you had a toothache that stopped, it is still worth having the tooth checked.
Should I take antibiotics for a toothache?
Not on your own. Antibiotics do not relieve the pain of an inflamed nerve, which is the most common cause of toothache. They are prescribed by a dentist or doctor when an infection is spreading, for example with facial swelling or fever, alongside treatment of the tooth itself. Do not use leftover antibiotics.
Is a toothache with fever or swelling dangerous?
It can be. Swelling of the face or under the jaw together with fever suggests a dental infection that is spreading. If the swelling is increasing, reaching the eye or neck, or making it hard to open your mouth, swallow or breathe, go to a hospital emergency department straight away.
Can I see Toothsmith for a toothache the same day?
Call or WhatsApp us as early in the day as you can. We set aside time for patients in pain and will see you as early as we can, the same day where possible. We are open Monday to Saturday, until 9pm on Tuesday and Thursday, and closed on Sundays and public holidays.
Sources
- National Dental Centre Singapore, Emergency dental services
Questions about your teeth?
Book a check-up. You will hear what we find, the options and the fee before anything is done.