How to Sleep With a Toothache: 7 Steps That Help Tonight

It is past midnight. The house is quiet, the lights are off, and your tooth is pounding like it has its own heartbeat. Every time you start to drift, the throb pulls you back. You keep checking the clock and doing the math on how few hours are left.

Here is how to sleep with a toothache tonight, in short: take a pain reliever as the label says, rinse with warm salt water, hold a wrapped cold pack against your cheek for about 20 minutes, then lie back with your head raised on an extra pillow and slow your breathing down with long breaths out. That will not fix the tooth. It can take the edge off enough for you to rest until you can call a dentist.

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It is the free 5-minute sleep reset: slow breathing with a long breath out, then one simple grounding step, all lying down in the dark.

Why a toothache feels worse at night

During the day you have noise, people and tasks. At night all of that drops away, and the only thing left to notice is the ache. Many people find the same pain that was a 4 out of 10 at lunch feels like an 8 at 1am.

Position plays a part too. A UK dental service, Wirral Community Health and Care NHS Trust, advises keeping your head raised at night with an extra pillow, because it can relieve pressure within the tooth and reduce pain. Lying flat does the opposite.

Then there is the loop that keeps you up long after the pain has eased. The Sleep Foundation’s guide to pain and sleep explains that one of the main ways pain disrupts sleep is by keeping the central nervous system aroused. You hurt, you worry about not sleeping, the worry winds you up, and a wound-up body feels pain more sharply. Breaking that loop is half of tonight’s job.

How to sleep with a toothache: a plan for tonight

Work through these in order. The whole thing takes about 30 minutes, and most of it you can do sitting on the edge of the bed.

1. Take a pain reliever, exactly as the label says (2 minutes)

The NHS toothache page and Cleveland Clinic both list over-the-counter pain relievers such as ibuprofen or acetaminophen (called paracetamol in the UK) to ease the pain while you wait for a dentist. Check the box for the dose and how long to wait between doses, and check what you have already taken today. If you take other medicines or have a health condition, a pharmacist can tell you what is safe for you.

One thing not to do: Mayo Clinic warns against putting aspirin or any painkiller directly on your gums, because it can burn the tissue. Swallow it, don’t place it.

2. Rinse with warm salt water (2 minutes)

Cleveland Clinic suggests mixing half a teaspoon of salt into 8 ounces of warm water, swishing for 30 seconds and spitting it out. It is a gentle way to clean around the sore tooth before bed. If something is stuck near the tooth, gentle rinsing may help, but the NHS advises using a soft toothbrush and not flossing around the sore tooth itself.

3. Cold on the outside of your cheek (about 20 minutes)

Wrap a bag of ice or frozen peas in a clean towel and hold it against the outside of your jaw for about 20 minutes. Cleveland Clinic says cold helps shrink blood vessels and reduce pain and inflammation. Use this time to sit quietly with the lights low rather than scrolling. Never put ice straight on skin, and never put heat on a swollen face; the Wirral dental service warns that heat can make facial swelling worse.

4. A numbing gel, if you have one (1 minute)

The NHS mentions pain-relieving mouth gels from a pharmacy or supermarket. If you have one in the bathroom cabinet, follow the instructions on the pack. If you don’t, skip this step. Nobody needs a 2am drive to a store.

5. Prop your head up (1 minute)

Add a pillow, or two if that’s comfortable, so your head sits higher than your chest. More on positions below.

6. Slow your breathing down (5 minutes)

Once you are lying back, breathe in gently through your nose, then let a long, slow breath out, longer than the in-breath. Try in for 4, out for 6 to 8. You can use the 4-7-8 breathing pattern lying in bed if you know it; if holding your breath feels uncomfortable with a sore mouth, just keep the long exhale.

There is decent evidence behind slow breathing with long exhales. In a 2023 Stanford study, five minutes a day of breathing with extended exhales improved mood and slowed breathing rate, more than the same time spent on mindfulness meditation. It won’t touch the tooth. It can calm the wired, on-alert feeling that keeps the pain front and center.

7. Let your body go heavy, one part at a time (5 minutes)

Your jaw will want to clench around the pain. Notice it, and let it hang a little loose, lips together, teeth apart. Then move your attention away from your mouth: feet, calves, hands, shoulders. Feel each part get heavier against the mattress. Our guide on how to relax your body to sleep walks through this step by step.

The best position to sleep with a toothache

Head up. An extra pillow, a wedge pillow, or a recliner if lying down feels much worse. The goal is your head higher than your heart.
Not on the sore side. Pressure from the pillow on that cheek can wake you each time you roll over. Lie on your back or the opposite side.
Support behind you. If you tend to roll onto the sore side, a pillow tucked behind your back makes it harder to turn over in your sleep.

What not to do at 2am

Don’t snack on something sweet, very hot or very cold. The NHS lists all three as things to avoid with toothache. If you are hungry, something soft and lukewarm, chewed on the other side, is kinder.
Don’t drink alcohol to numb it. A nightcap can feel like it helps you drift off, but our page on why alcohol wakes you up at night explains why it tends to break up sleep later.
Don’t double up on painkillers because the first dose hasn’t worked yet. Stick to the label. If the pain does not ease with painkillers at all, that is a reason to get help, not to take more.
Don’t lie there fighting it for hours. If you have been awake and miserable for around 20 minutes, the Sleep Foundation suggests getting up, going to another room and doing something quiet until you feel sleepy. Our guide to how long to stay in bed when you can’t sleep covers how to do this without waking yourself up more.

When a toothache at night is an emergency

Most toothaches can wait for the dentist in the morning. Some can’t. Go to an emergency room, or call 911, if you have toothache together with any of these (from the NHS and Cleveland Clinic):

Swelling around or below your eye, or in your neck.
Swelling in your mouth or neck that makes it hard to breathe, swallow or speak.
A fever over 101°F (38.3°C).
Unbearable pain that does not get better with medication.
Bleeding that won’t stop when you press on it.

The NHS adds: don’t drive yourself if you have those symptoms. Ask someone to take you, or call for an ambulance.

Cleveland Clinic also notes that unbearable tooth pain with fever and chills is a dental emergency, because although it is rare, an infection in the mouth can spread.

Tomorrow morning: get the tooth looked at

Everything above buys you rest. It doesn’t treat the cause. Cleveland Clinic is clear that pain relievers and even antibiotics only ease symptoms for a while, and a true toothache usually means something needs treatment, like a cavity, a cracked tooth, a loose filling or an infection.

Call your dentist as soon as the office opens. The NHS advises seeing a dentist if the pain lasts more than 2 days, doesn’t go away with painkillers, or comes with a high temperature, pain when you bite, red gums, a bad taste in your mouth, or a swollen cheek or jaw. If your dentist is closed, their voicemail often tells you who to call out of hours.

It helps to jot down a few things before the call: when the pain started, what makes it worse (biting, hot drinks, lying down), and what medicine you took and when. That makes a short appointment far more useful.

If the ache is from clenching or grinding

Not every sore tooth is a cavity. Cleveland Clinic lists teeth grinding and clenching as a cause of toothache, and says a dull, persistent ache can be a sign that you grind your teeth in your sleep. If you wake with a tight jaw, sore teeth on both sides, or a headache, mention it to your dentist. Our page on jaw clenching at night has ideas for loosening up before bed, and if the pain spreads into your head, see how to sleep with a headache.

Questions people ask at 2am

Can a toothache really keep you awake all night?

Yes, and it is not a sign you are being dramatic. The Sleep Foundation describes how pain both shortens sleep and causes more waking in the night. The steps above are about lowering the pain enough, and calming your body enough, that sleep has room to come back.

Is cold or heat better for a toothache at night?

Cold, wrapped in a towel, on the outside of your cheek. Avoid heat on any swelling in your face.

How long will the toothache last?

Cleveland Clinic says there is no way to know without finding the cause. Irritated gums may settle in a day or two. A cavity or abscess may come and go, but it won’t go away on its own.

I’m so tired. Will one bad night wreck tomorrow?

It will probably feel rough, and that is OK. One short night is survivable. Worrying about it is often what keeps people up longer than the tooth does. If that’s you, read how to stop worrying about not sleeping tonight, and remember that resting quietly with your eyes closed still counts for something.

Rest now, fix it tomorrow

Tonight, you don’t have to solve the tooth. You only have to get the pain down a notch, get your head up, and give your body a reason to stand down. Tomorrow you call the dentist, get it treated, and get your nights back.

If you want a calm, guided way to do the switching-off part, the reset takes five minutes and you do it lying down.