If you’ve ever tried to fall asleep while dealing with a toothache, you’re not alone in noticing that dental pain often feels more intense at night. Even mild discomfort during the day can turn into throbbing, hard-to-ignore pain once your head hits the pillow. But why does this happen? Several factors can make nighttime toothaches feel worse — and understanding them can help you find relief until you can see your dentist.
Changes in Blood Flow Increase Pressure
When you lie down, blood flow naturally increases to your head. While this is normal, it can also increase pressure around an inflamed or infected tooth. This additional pressure intensifies pain, making a toothache that was manageable during the day suddenly feel sharp or throbbing at night. Gravity plays a big role here: staying upright helps reduce pressure, while lying down amplifies it.
Fewer Distractions Make Pain More Noticeable
During the day, your mind is occupied with work, conversations, and everyday tasks. At night, however, things grow quiet — and without distractions, your brain focuses more on physical sensations. Pain that felt mild before becomes harder to ignore when there’s nothing else competing for your attention.
Nighttime Habits Can Trigger Discomfort
Several nighttime behaviors can make a toothache worse. For example, many people clench or grind their teeth in their sleep, which can aggravate tooth sensitivity, wear enamel, or irritate the nerves inside the tooth. Even eating dinner late at night — especially hot, cold, or sugary foods — can trigger lingering sensitivity that becomes more noticeable when you lie down.
If you suffer from acid reflux, nighttime heartburn can also worsen tooth pain. Stomach acid in the mouth can irritate already sensitive or damaged teeth.
Sinus Pressure Can Intensify Tooth Pain
If your toothache is coming from your upper back teeth, sinus issues may be part of the problem. When your sinuses become congested or inflamed, pressure can build and radiate into your teeth. At night, congestion often worsens as you lie down, which can make sinus-related toothache feel sharper.
You’re Delaying Treatment
A toothache that consistently worsens at night may be a sign of a deeper problem, such as a cavity, cracked tooth, or infection. These issues don’t get better on their own. The longer they go untreated, the more likely the pain will intensify — especially at night when pressure and inflammation become more noticeable.
If your toothache lasts more than a day or two, keeps you awake, or is accompanied by swelling, fever, or sensitivity, it’s time to schedule an appointment. Your dentist can identify the cause and recommend appropriate treatment to relieve your discomfort.
About the Author
Dr. Brian Lavery has more than 40 years of experience practicing dentistry! He completed his dental training at the New Jersey Dental School. He has well over 1,000 hours of continuing education, focusing in recent years on dental implant placement and restoration. Have a toothache that won’t quit? We can help! Schedule an appointment online or call (609) 588-5600.