Gangseo-gu Hwagok Dental Clinic: Why Toothache Gets Worse at Night

Director Kim Geun-il of 365 Seoul One Top Dental Clinic

Hello.

I am Kim Geun-il, the director of 365 Seoul One Top Dental Clinic.

Have you ever felt that toothache is particularly harder to endure at night than during the day?

The main reason toothache that was bearable during the day becomes worse as soon as you lie down to sleep is “an increase in pressure inside the tooth caused by a change in posture.”

When you lie down, blood flows toward your head, causing the pressure inside the tooth’s inflamed and swollen nerve tissue to rise rapidly. This results in a throbbing pain that feels as though your heart is pounding inside the tooth.

After treating countless patients in the clinic for more than 10 years,

I often meet people who come in for emergency treatment saying,

“I was in so much pain at night that I couldn’t sleep at all...”

Today, I will summarize the medical causes of toothache becoming particularly severe at night and the guidelines for measures you can take right away.

3 Causes of Toothache Suddenly Becoming Worse at Night

Blood flowing toward the head when you lie down (Increased pressure)

When you are standing or sitting, gravity allows blood to flow evenly throughout the body.

However, the moment you lie down in bed, your body becomes horizontal and blood flow to the head increases by approximately 20–30%.

If the “pulp (nerves and tiny blood vessels)” at the center of the tooth is inflamed, the blood flowing toward the head causes the pressure inside the tooth to expand.

Because the tooth is enclosed on all sides by its hard outer structure, there is nowhere for the pressure to escape. It strongly compresses the nerve and causes severe pain.

Reduced secretion of the anti-inflammatory hormone cortisol and fewer distractions

Between midnight and 4 a.m., our bodies produce the “cortisol” hormone, which has a natural anti-inflammatory effect, at the lowest level of the day.

In addition to the decline in hormone levels that helped calm inflammation, the noise and activity of daily life disappear, allowing the brain to focus solely on pain signals from inside the mouth.

As a result, the pain is inevitably felt more intensely.

Reduced saliva secretion in the mouth during sleep

Do you ever wake up in the morning and feel that your mouth is dry?

This is because saliva secretion during sleep decreases to less than half of its daytime level.

When saliva’s cleansing action and ability to regulate acidity decrease, bacterial activity in the mouth rises rapidly. In particular, if you have a habit of breathing through your mouth, swelling and pain in the gums can worsen significantly.

Emergency Measures for Toothache at Night

If it is late at night and difficult to visit a dental clinic immediately, I recommend taking the following three measures first.

Raise your pillow by 15–20 cm

Change the position of your pillow while lying horizontally, and keep your head higher than your chest. This can reduce the amount of blood flowing toward your head and lower the pressure inside the tooth.

Take an anti-inflammatory pain reliever containing ibuprofen or dexibuprofen

Rather than acetaminophen (Tylenol), which is intended simply to block pain, taking an anti-inflammatory pain reliever that reduces the inflammation itself can be much more effective.

Cold ice compress

Warm or cold compress?

Have you been unsure which type of compress would help?

The answer is a cold compress.

A cold compress constricts blood vessels and lowers pressure, so it may help relieve pain.

In cases of acute pulpitis, holding cold water in your mouth may temporarily reduce the pain somewhat.

However, a warm compress dilates blood vessels and can worsen the inflammation, so you should avoid it completely.

People who should visit a dental clinic without hesitation

Even if your pain subsides in the morning after taking a pain reliever, this does not mean that the condition has healed.

The nerve may be temporarily numbed, making it impossible to feel the pain, while the inflammation continues to progress internally.

If you experienced pain that was difficult to endure throughout the night, I strongly recommend getting an examination as soon as possible.

[People who definitely need an in-person examination]

1. People who have taken pain relievers every night for the past three days and were barely able to fall asleep

2. People who feel a heartbeat-like, pulsating sensation in a tooth when lying down

3. People whose pain temporarily decreases when they hold cold water in their mouth

(A typical symptom of acute pulpitis)

Toothache is truly difficult to endure.

In addition, recurring toothache can gradually cause your daily life to break down.

Therefore, do not endure it; I recommend visiting a dental clinic as soon as possible.

I, dentist Kim Geun-il, will always do my best for your peaceful nights and healthy smiles.

Thank you.

📍 365서울원탑치과의원

4th Floor, Dongmyeong M Building, 179 Gangseo-ro, Gangseo-gu, Seoul

Dental clinic/Gangseo-gu dental clinic/Hwagok-dong dental clinic

A 1-minute walk from Exit 8 of Hwagok Station