Toothache Out of Hours

What to Do About Toothache at Night or the Weekend

Most toothache can be managed safely until the next working day. Take an over-the-counter painkiller at the dose on the packet, sleep with your head raised, and keep hot, cold, sweet and hard food away from the sore tooth. Then call us as early as you can on the next weekday.

Some situations shouldn't wait. If swelling is spreading or you feel unwell, call NHS 24 on 111 for urgent dental advice. If swelling affects your breathing, swallowing or eye, or you have heavy bleeding that won't stop or a serious facial injury, call 999 or go to A&E.

The sections below explain each of these steps, and how to judge which group you're in.

Why Does Toothache Get Worse When You Lie Down?

Many people find a sore tooth that was bearable during the day becomes unbearable at bedtime. There are a few reasons for this.

• Blood flow. Lying flat increases the blood pressure in your head. Inside a tooth, the nerve sits in a rigid chamber with no room to swell, so extra pressure on inflamed tissue is felt as throbbing.
• Fewer distractions. In a quiet, dark room your brain has nothing else to attend to, so the pain seems louder.
• Painkillers wearing off. A dose taken in the early evening may be fading by the small hours.
• Clenching. Some people clench or grind in their sleep, which makes a tender tooth worse.

Pain that wakes you, or throbs on its own without any trigger, usually means the nerve is significantly inflamed. It may ease for a while but rarely settles for good without treatment, so book in even if it calms down.

Safe Pain Relief: Getting the Dose Right

Over-the-counter painkillers work well for most toothache when taken properly.

• Ibuprofen reduces inflammation as well as pain, which suits toothache. It isn't suitable for everyone: check with a pharmacist if you have asthma, stomach ulcers, kidney or heart problems, take blood thinners, or are pregnant.
• Paracetamol suits most people, including many who can't take ibuprofen.
• Follow the dose and timing on the packet. Taking more doesn't give more relief and can cause serious harm. Check cold and flu remedies, which often contain paracetamol too.
• Ask a pharmacist whether combining or alternating paracetamol and ibuprofen is right for you. Pharmacies are often open in the evening and at weekends.
• Aspirin isn't suitable for children under 16.

Never put an aspirin against the gum or tooth. It doesn't work that way, and it causes a painful chemical burn to the gum.

Don't take leftover antibiotics or someone else's prescription. They won't reliably help toothache and may make a proper diagnosis harder.

What Helps, and What Doesn't

A few simple measures make a real difference overnight.

If the pain started after food got stuck between two teeth, careful flossing can sometimes bring quick relief. If a filling or crown has come out, cover the area and keep it clean until we can see you.

What Type of Toothache Is It?

The way a tooth hurts gives useful clues, and helps you decide how soon to be seen.

• A short, sharp twinge with cold or sweet things that fades in seconds is usually sensitivity or a small cavity. Unpleasant but rarely urgent.
• Pain that lingers for minutes after hot or cold, or comes on by itself suggests the nerve is inflamed. Call us as soon as we're open.
• Constant throbbing, a tooth that feels "high" or tender to bite on, or a bad taste often points to infection. Call early; same day if possible.
• Sharp pain when you bite and then release can mean a cracked tooth.
• Soreness at the back of the mouth with swollen gum around a partly erupted wisdom tooth is common in young adults and often settles with cleaning and salt-water rinses, but it can spread.

These are general patterns, not a diagnosis. Two problems can produce similar pain, and only an examination and X-ray will tell them apart.

When Can Toothache Wait Until a Weekday?

It's usually safe to manage at home until we're open if:

• painkillers at the packet dose are controlling the pain well enough to sleep
• there's no swelling of the face or gum
• you don't have a temperature and feel otherwise well
• you can eat and drink, even if you're chewing on one side

Keep taking pain relief as directed and call us as early in the day as you can. Toothache that eases over the weekend still needs looking at: a nerve can stop hurting because it's dying, and infection can return later, sometimes more severely.

When to Call 111 Or 999

We're open Monday to Friday, 9am to 5.30pm, and closed at weekends. Outside those hours:

Call NHS 24 on 111 for urgent dental advice if:

• swelling in your gum or face is getting bigger
• you have a temperature or feel generally unwell alongside the toothache
• pain is severe and not controlled by painkillers taken at the right dose
• bleeding after an extraction continues despite firm pressure

Call 999 or go to A&E if:

• swelling is affecting your breathing or swallowing
• swelling is spreading to, or closing, your eye
• you have heavy bleeding that won't stop
• you have a serious facial injury

These are the situations where waiting for the morning isn't safe. If you're in doubt, phone 111 and explain your symptoms.

What Happens When You Call Us in the Morning?

Call 0131 332 3971 as early in the day as you can. Our emergency appointments run on weekdays, and same-day slots go quickly.

On the phone, we'll ask where the pain is, how long you've had it, what sets it off, whether there's any swelling, and about your medical history and medication. This helps us judge how urgently you need to be seen.

At the appointment, which is £75 for registered patients and £99 if you're not registered, we'll:

1. examine the tooth and surrounding gum
2. take an X-ray if needed
3. carry out simple tests, such as how the tooth responds to cold or tapping
4. explain what we've found and your options

To get you comfortable, the first step might be a dressing or temporary filling (£60), removing the inflamed nerve as the first stage of root canal treatment (£110), draining an abscess, or taking the tooth out where it can't be saved. We'll always explain the choices, including keeping versus removing the tooth, and agree any further fees in writing before we start.

Can You Stop It Happening Again?

Most night-time toothache comes from problems that build up quietly: decay under an old filling, a crack, gum disease or a tooth that has already been sore on and off. Regular dental examinations and hygiene visits catch many of these early, while the fix is smaller.

If you've had a twinge that comes and goes, don't wait for it to become a 2am problem. Patients from Comely Bank, Stockbridge and the rest of Edinburgh can book a routine examination, and our new patients page explains how to register.

Questions

This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.