Signs that need emergency medical care
A small number of dental problems need emergency medical attention rather than a dental appointment, and they are not judged by how much the tooth hurts.
Seek emergency medical care if a toothache or swelling comes with:
- Problems with breathing
- Problems with speaking
- Swelling around the eye or the neck
Difficulty swallowing that is severe or getting worse also needs prompt assessment rather than waiting.
These can indicate an infection spreading into areas that affect the airway. That applies regardless of the hour and regardless of how severe the pain itself is.
Pain from the heart can sometimes be felt in the jaw or teeth. If jaw pain comes with chest pain, breathlessness, sweating or nausea, treat it as a medical emergency rather than a dental one.
Why toothache can feel worse at night
When the nerve inside a tooth becomes significantly inflamed, clinical guidance describes pain that can keep a person awake at night. The same pattern often includes pain that starts without an obvious trigger, pain that is hard to pinpoint to one tooth, and a dull ache that lasts for hours rather than seconds. Heat often makes it worse, and cold sometimes relieves it.
Night pain can suggest this kind of inflammation, but it cannot establish a diagnosis on its own. Several different problems can produce pain that is worse at night, and only an examination, usually with imaging, can identify which one applies.
Fewer distractions at night also make any pain more noticeable, which is part of the picture.
What different kinds of pain can suggest
Short, sharp sensitivity that stops as soon as the trigger is removed may indicate exposed dentine, a worn area, or an early problem.
Pain that starts on its own, lingers and disturbs sleep may indicate that the nerve inside the tooth is significantly inflamed. This pattern is worth having assessed promptly rather than monitored.
Pain on biting may point to a cracked tooth, a problem at the root tip, or a restoration sitting high.
Pain with swelling suggests infection, and the swelling is often more informative than the pain. Where swelling is spreading, the urgency changes considerably.
None of these patterns is conclusive on its own. They are useful to describe when you call, not to diagnose yourself with.
When to seek urgent dental care, and when it can wait
Contact a dentist as soon as you reasonably can if you have:
- Toothache lasting more than two days, or not improving
- A fever above 38°C
- Trouble swallowing
- Pain when biting
- A bad taste in the mouth, which can indicate pus draining
- Swelling in the cheek or jaw
These mean the problem needs attention rather than waiting to see whether it passes. If symptoms are worsening at any point, seek help sooner rather than later.
What can usually wait for a normal appointment: brief sensitivity to cold or sweet things, mild discomfort around a filling, or an ache that settles quickly and has not recurred.
Getting advice on pain relief
What is appropriate for pain relief depends on your medical history, your other medications and your age. It is worth asking a pharmacist, your GP or your dentist rather than following a general list online.
Antibiotics do not treat an inflamed tooth nerve. They have a role where infection is spreading, and that is a decision for a clinician who has examined you.
What a hospital emergency department can and cannot do
An emergency department can assess you, manage pain, and treat a spreading infection that threatens the airway. That is the right place for the emergency signs described earlier, including swallowing difficulty that is severe or getting worse.
What an emergency department generally cannot do is treat the tooth. There is usually no dentist on site and no dental equipment, so you will still need a dentist for the underlying problem.
New South Wales also runs public dental services with emergency provision for eligible people, which is worth knowing if cost is a barrier.
What to have ready when you call
Having these to hand makes the conversation faster and more accurate:
- How long the pain has lasted and whether it is constant or comes and goes
- What makes it worse or better, particularly hot and cold
- Whether it wakes you or keeps you awake
- Whether there is any swelling, and whether it is changing
- Whether you have a fever or feel generally unwell
- Any medications you take and any medical conditions
- Whether the tooth has been treated before
Getting seen
If a toothache has kept you awake, it is worth having looked at rather than waiting to see whether it settles. A dentist in Sydney can examine the tooth, take the imaging needed to see what is happening below the surface, and explain the options.
Emergency dental care is available for urgent problems, and the clinic can tell you what is possible and when.
Frequently Asked Questions
Why does my tooth hurt more at night?
Pain that disturbs sleep can be a feature of inflammation inside a tooth, and fewer distractions at night make any pain more noticeable. It is a useful thing to mention when you call, but it does not identify the cause on its own.
Should I go to hospital for a toothache?
Go to an emergency department if you have difficulty breathing or speaking, swelling around the eye or neck, or swallowing difficulty that is severe or getting worse. An emergency department can assess you, manage pain and treat a spreading infection, but it generally cannot treat the tooth itself, so you will still need a dentist afterwards.
Will the pain go away on its own?
Sometimes the pain settles while the underlying problem continues, which can be misleading. Pain that stops after being severe is not necessarily a sign of improvement.
Can I wait until Monday?
It depends on what else is happening. Swelling, fever, difficulty swallowing or pain that is not improving after two days should not wait, and anything that is getting worse should be seen sooner. Brief sensitivity usually can wait.
Do I need antibiotics?
Not for an inflamed nerve. Antibiotics have a role where infection is spreading, and that is a judgement for a clinician who has examined you.
Written by the Hayat Dental team
Dr Abhishek Aggarwal, Dr Joanne McGilp and Masi Hashimi care for patients at our Broadway clinic in Chippendale.
Meet the teamThis article is general information only and is not a substitute for a dental assessment. If you have pain or swelling, call the clinic.
