What hurts at night and why
If you wake up at three in the morning with throbbing toothache, the cause is almost never a new trigger, but an inflammation that has already announced itself during the day. In supine position the pulp fills more strongly with blood, pressure rises, and inflamed tissue reacts with pain often described as throbbing or pulling.
The most common causes for nighttime toothache are, in descending frequency:
Reversible pulpitis. A pulp irritated by deep caries or a leaking filling. Pain occurs briefly with cold or sweet stimulus and subsides within a minute. Treatable with caries restoration or filling change.
Irreversible pulpitis. The inflammation has become independent, the pulp can no longer recover. Pain lasts for minutes, comes spontaneously, often especially at night. Treatment is a root canal treatment or in rare cases extraction.
Apical abscess. The inflammation has left the root canal and gathers at the root tip. Pressure pain when biting, often swelling. Treatment is a root canal treatment with relief, in severe cases with antibiotic.
Periodontal abscess. The inflammation sits in the gum-bone area at the side of the tooth, not at the root tip. Frequent with advanced periodontitis. Treatment is an incision and thorough dental hygiene session, if necessary with surgical cleaning of the gum pocket.
How we treat you
If you call us in the morning, you get an emergency appointment the same morning or afternoon. We do focused medical history, vitality test, percussion and pressure test, and if needed an X-ray. Based on these findings we plan treatment in the same session, where possible.
For reversible pulpitis the removal of caries and a build-up in one session is often sufficient. For irreversible pulpitis the root canal treatment begins immediately, with pain relief as the first goal. For abscess we mechanically relieve the pus, this usually brings significant pain relief within minutes.
In all cases you receive a written plan with costs before treatment begins. We do not treat first and then send you a bill.
When pain radiates
Toothache that cannot be unambiguously assigned to a tooth but radiates to temple, jaw or ear, can also have another cause. Possible differential diagnoses are a TMJ dysfunction with nighttime grinding, a sinus inflammation that projects onto upper jaw teeth, or trigeminal neuralgia. We clarify this in the examination and refer if necessary.
If you simultaneously have difficulty swallowing, pronounced swelling or fever, this is a medical emergency that cannot wait. Immediately call the closest Resident acute number or the medical emergency service.
Prevention for the next night
If the pain is due to pulpitis from undetected caries or a crack, the most important prevention is the regular dental hygiene session. For patients who grind or press at night, an individually fitted night guard is the most effective protection against recurring pain.
Before the appointment ideally note: When was the first pain? What does it react to? How long does it last? This information speeds up diagnosis and saves you time at the treatment chair.