Severe Toothache at Night — Emergency Care in London
Toothache often feels worse at night. Lying flat increases blood flow to the head, fewer distractions amplify pain perception, and pulpal (nerve) pain typically follows a throbbing pattern that is most noticeable when you are still. This page explains how to get through the night and how to be seen as quickly as possible the next morning.
Flat £30 emergency assessment fee for everyone. X-rays (£20/image, £10 for members) and onward treatment quoted separately in writing before treatment.
What to Do Right Now
- →Take ibuprofen and/or paracetamol at the recommended dose (check the packaging and your medical history). Combining them is acceptable at recommended doses for most adults.
- →Sleep with your head slightly raised on extra pillows — this reduces pulsing.
- →Rinse with warm salt water before bed.
- →A cold compress on the cheek (15 minutes on, 15 minutes off) can help.
- →Avoid hot or cold drinks. Avoid alcohol — it can interact with painkillers and disturb sleep.
- →Call NHS 111 if pain is severe, you cannot manage with over-the-counter pain relief, or there is swelling, fever or difficulty swallowing.
- →Book the first available appointment for the morning.
Call 999 or go to A&E
If you develop spreading facial swelling, difficulty breathing or swallowing, voice changes, drooling, or feel severely unwell with fever, call 999 or go to A&E — do not wait for the morning.
How We Treat Toothache at Night
In the morning we will assess the cause (deep decay, irreversible nerve inflammation, abscess, cracked tooth, etc.) and treat accordingly — a filling, root canal treatment, drainage of an abscess or extraction. We will be honest about prognosis and provide a written quote before treatment.
Cost & what is included
Emergency assessment is a flat £30 for everyone — this includes the clinical examination and pain triage. X-rays (charged at £20 per image, £10 for members) and any onward treatment are quoted separately and confirmed in writing before treatment goes ahead. We will explain options and prognosis honestly; you are free to take time to decide or to seek a second opinion.
Common Causes
Understanding what has caused the problem helps you take the right next step — and helps us choose the right treatment. The most frequent reasons we see in clinic are:
- •Irreversible pulpitis — the nerve of the tooth is dying and causes severe pain when you lie flat.
- •Dental abscess flaring up overnight.
- •A cracked tooth that has progressed.
- •Pericoronitis around a wisdom tooth (often worse at night).
- •Sinusitis can mimic upper-back tooth pain, especially when lying down.
Treatment Costs — Guide Prices
All prices below are guide prices for treatments most commonly needed for this kind of emergency. Your written treatment plan after the assessment will confirm the exact figure for your situation, before any treatment goes ahead. SPMD Dental Membership typically saves 50% on most dental treatments (terms apply).
| Treatment | Standard price | Member price |
|---|---|---|
Emergency dental assessment Flat £30 for everyone — examination + pain triage. | £30 | £30 |
Dental X-ray (per image) Only charged if clinically required. | £20 | £10 |
Root canal — front tooth (incisor/canine) Crown usually recommended afterwards. | from £695 | from £347.50 |
Root canal — molar Crown usually recommended afterwards. | from £895 | from £447.50 |
Tooth extraction (simple) For non-surgical removal. | from £250 | from £125 |
Abscess drainage (incision) Where a localised abscess can be drained. | from £150 | from £75 |
Emergency assessment is a flat £30 for everyone (this is the standard rate — the membership discount does not apply to the assessment itself). Multi-visit treatments (e.g. root canal + crown) are quoted together so you can see the full cost up front. We never start treatment without your written agreement.
After Your Appointment
You will leave with written aftercare specific to your treatment. As a general guide, the following points apply to most patients seen for this kind of emergency:
- ✓After definitive treatment, follow the aftercare specific to the procedure (e.g. root canal, extraction).
- ✓Tenderness for a few days is normal and usually settles with simple painkillers.
- ✓Avoid chewing hard foods on a tooth that has just been root-canal-treated until the final restoration is in place.
- ✓Contact us if pain worsens, swelling develops, or you feel feverish.
If anything worries you between appointments, phone the clinic — we would much rather hear from you early than late.
Frequently Asked Questions
Why is my toothache worse at night?
Several reasons — lying flat increases blood pressure to the head, you have fewer distractions, and pulpal pain tends to throb. None of this means the problem is more serious at night; it just feels worse.
Should I call 111 in the middle of the night?
Yes if you cannot control the pain, there is significant swelling, fever, or you cannot wait until morning. 111 can direct you to an out-of-hours dentist or A&E if needed.
Can I take painkillers throughout the night?
Yes, at the recommended dose intervals. Read the packaging carefully. Do not exceed maximum daily doses. Check with a pharmacist if you take other regular medication.
What should I avoid doing?
Avoid placing aspirin on the gum (it causes burns), avoid heat on the face (can spread infection), avoid alcohol with painkillers, and do not try to drain a swelling yourself.
Other Dental Emergencies
Looking for help with something else? See our other emergency dentist pages:
Need to be seen now?
Call the clinic nearest to you. Same-day emergency appointments are subject to clinical availability — we will give you the soonest realistic slot. Out of hours, NHS 111 can also help.
SPMD Medical & Dental is regulated by the Care Quality Commission (CQC) and our clinicians are registered with the General Dental Council (GDC). If at any point you are unhappy with your care, we welcome your feedback. Our complaints procedure is published on our website and a copy is available on request.
