Why Do I Have A Toothache At Night & When I Lie Down?

Pulpitis is inflammation of the pulp chamber located in the tooth's center. There are various reasons that the center chamber may become inflamed. For example, you may have hit your tooth in the past or have decay reaching the pulp chamber. Whatever the cause is, the inflammation is a response of your body to try and heal the tooth because it senses a problem. The inflammation can create pressure in your tooth and often makes it sensitive to cold. However, for some people with pulpitis, lying down increases the pressure in the head and further increases pressure into the tooth. This pain will commonly manifest as a throbbing and aching in the tooth.

There are two degrees of pulpitis: reversible and irreversible. Reversible means the tooth may heal without treatment, and the condition will eventually disappear. Irreversible means the tooth won’t heal and need a root canal to save the tooth. A dentist can test this out for you or read this article on cold sensitivity.

In the meantime, over-the-counter ibuprofen three times a day for three days is one thing I tell some of my patients to do to reduce inflammation and pain. In addition, Ibuprofen can help reduce the possibility of reversible pulpitis progressing into irreversible. Finally, at night it is recommended to sleep with your head propped up to minimize the throbbing.

The pain of a dental abscess is partly due to an increase in pressure of a pocket filled with infection. In addition, when lying down at night, there is more fluid pressure in the head which also increases the pressure in the abscess. The increased pressure can start the pain or make the pain worse.

An abscessed tooth will need a root canal or extraction as a permanent solution because it lost its blood supply from trauma or irreversible pulpitis. Without a blood supply, infection easily settles in the pulp chamber and then migrates out of the tooth, forming a pocket or abscess. This abscess is the cause of pain while lying down. For some, it feels like a heartbeat in your tooth or jaw. A dental abscess requires a root canal because it seals off the pulp chamber, which has become the breeding ground, and the body fights off the rest of the infection.

Propping your head up will help reduce the pain from lying down with a dental abscess.

Antibiotics will only partially fight off the infection of a dental abscess but is an option for temporary relief. Antibiotics only fight the abscess portion of the infection in the jaw and cannot adequately reach the bacteria inside the tooth without a blood supply. If your pain temporarily resides with antibiotics, it will come back soon after, likely resistant to some antibiotics. Antibiotics are not a recommended treatment unless the infection has become systemic.

The next possibility of a toothache at night is clenching and grinding, known as bruxism. Clenching causes excess pressure on the ligaments that hold your teeth in place. The pressure triggers inflammation of the ligaments and causes your teeth to ache and throb. Involuntary teeth clenching usually happens at night when people sleep, but it can also occur during the day. Unfortunately, most people don’t realize they are clenching and grinding and night.

A slight pain that is difficult to locate is an indicating factor that you have excessive nighttime clenching. Further, people with bruxism pain commonly can’t even pinpoint the pain to the top or bottom teeth. Clenching and grinding will also manifest as a pain that only comes when chewing for some people or a spontaneous pain for others. A sign that you may clench and grind your teeth at night is if you have a lot of worn-down teeth with or without a lot of chipping and cracks.

Because the subject of clenching and grinding is vast, I have a whole article here on all the causes of it and TMJ, including how to find relief.