Help! I’ve Extreme Tooth Pain And Can’t Sleep

Written & Reviewed by Dr David Chen

If you’re having extreme tooth pain and can’t sleep, we’ve some toothache alleviating tips that’ll help you get through the night. That way when morning comes, you’ll be refreshed and ready to see your dentist so that you can eliminate the source of the pain permanently.

can't sleep
trouble sleeping

However, to be crystal clear, these toothache home remedies are not a replacement for seeing a dentist. They may temporarily help dampen the discomfort which means it will come back once it wears off.

Nonetheless, we do recommend giving these tips a try. If it works for you then that’s great. If they don’t and you really can’t take it, you may need to go to the nearest emergency department.

How to alleviate extreme tooth pain

You won’t be able to get rid of extreme tooth pain for good at home but you can at least temporarily relieve it. Here are some tips on how to reduce some of that pain so that you can get some sleep.

We want you to make it through the night so that you can see your dentist. Also to temper your expectations, please don’t expect these to get rid of your pain instantly. They take time to work and clam down the tooth.

How to alleviate a toothache at home:

  1. Take systemic painkillers.
  2. Use a topical analgesic.
  3. Rinse with salt water.
  4. Brush and floss your teeth.
  5. Use a tooth desensitizer.
  6. Apply cold compress.
  7. Avoid irritants.
  8. Sleep elevated.
  9. Call dentist.

Give these a try but just remember that they’re not a substitute for professional care. Home remedies may temporarily reduce some of the discomfort but won’t get rid of them forever.

Systemic painkillers

You were probably already taking painkillers for your toothache but they haven’t been working. Ibuprofen and acetaminophen are supposed to work for tooth pain!

We’re here to tell you that they weren’t helping because you were taking the wrong one. Currently, the most effective OTC pain reliever for severe tooth pain is Advil Dual Action.

Advil dual action - ibuprofen with acetaminophen
Advil dual action – ibuprofen with acetaminophen

Benefits of advil dual action:

  • Contains two painkillers, acetaminophen & ibuprofen in a single pill.
  • Those two medications work synergistically via different pain blocking mechanisms.
  • Pain relief comes systemically and is delivered via blood stream.
  • End result is a greater decrease in tooth pain.

In case you didn’t believe us, here is a chart from an actual study which compared the results. What researchers found was that the combination of ibuprofen and acetaminophen can be comparable to taking opioids.

acetaminophen with ibuprofen pain relief chart
Credit: Paul A. Moore, DMD, PhD, MPH; Hersh Elliot V., DMD, MS, PhD

Alternative to advil dual action

If this is in the middle of the night and all of the pharmacies are closed, you may not be able to purchase this painkiller. In that case, you can simply make your own.

Advil dual action conveniently combines acetaminophen with ibuprofen. You can get the same effect if you take those individual painkillers together.

What to take:

  • 1x 200 mg ibuprofen (motrin or advil)
  • 1x 500 mg acetaminophen (extra strength tylenol)
acetaminophen and ibuprofen

Note: If you only have the regular 325 mg acetaminophen, it is okay to take two of them instead of the 500 mg extra strength one.

Topical analgesics

For a bad toothache, just taking systemic painkillers won’t be enough. You need to block the pain from all angles and that includes alleviating it topically with an analgesic.

Common topical analgesics:

  • Orajel – we recommend using the Orajel 4x since it is the most powerful version of it.
  • Anbesol – interestingly, anbesol does not come in any other product variation so you don’t have a choice for this one!

Either one of them will work because they both contain 20% benzocaine which is the same numbing gel ingredient that your dentist uses. However, if you were to ask us to compare them, the Orajel 4x would be more effective in our opinion. It contains more analgesics than anbesol.

Home remedies

Not all home remedies have an analgesic property to them but some do.

  • Essential oils – Clove oil, tea tree oil, oregano oil, basil oil, peppermint oil, etc
  • Willow bark – contains salicin which is essentially aspirin (acetylsalicylic acid).
  • Toothache plant – it can block A-delta mechanonociceptors; it gives a mouth numbing effect.

Please stay away from the dangerous purported remedies like bleach, gasoline, and brake fluid. Those will cause you pain rather than alleviate them.

Salt water rinsing

Frequent rinsing with salt water can help minimize pain from an aching tooth.

  • Cleanses the mouth by washing away plaque, bacteria, and food debris.
  • Rebalances mouth pH by neutralizing acids in which bacteria thrive.
  • Antiseptic and helps reduce inflammation.

Often overlooked but its oral pH regulating ability can do wonders to control bacterial activity. Microbes work most effectively in low pH environments and less so in neutral pH.

Keep your mouth clean

The classic way to control the oral environment is to simply brush and floss. The effects and benefits parallel rinsing your mouth with salt water. Try to use a toothpaste meant specifically for sensitive teeth, which we’ll explain why below.

Desensitize the teeth

After you finish brushing your teeth, you should desensitize that aching tooth with sensitive toothpaste. Yes, with toothpaste but we bet you didn’t know that it can be used this way.

How to desensitize your tooth with sensitivity toothpaste:

  1. Apply sensitive toothpaste to the affected tooth.
  2. Rub it around the entire tooth and the gums.
  3. Let it sit for 10-15 minutes.
  4. Rinse out and repeat after every meal.
sensodyne rapid relief

Sensitive toothpastes:

  • Sensodyne
  • Colgate sensitive
  • Hydroxyapatite toothpastes

This is a well kept secret that dentists use to desensitize teeth with pulpitis from professional teeth whitening sensitivity. The inflamed tooth nerve can be calmed down by desensitizing it.

Cold compress

Applying a cold compress to the affected side of your face can help decrease the unbearable tooth pain. The cold will numb the area by giving a cooling sensation. The pressure applied to the face can also help keep the swelling under control.

How to use it:

  1. Place compress on affected side of face.
  2. Hold for 15 minutes.
  3. Remove for 15 minutes to give your face a break.
  4. Repeat steps #1-3 as needed.

Make sure to alternate the cold compress on and off, so you prevent frostbite to your face.

Avoid triggers

It is important to do things that don’t make your toothache worse. First, identify what triggers your pain and then avoid them at all costs.

  • If eating sweet or acidic food makes the pain worse, then you need to stop doing it!
  • If chewing on that side hurts, try to chew more on the opposite side!

Makes sense right? Don’t intentionally trigger the pain!

Sleep elevated

If you’re having a hard time sleeping, try placing an extra pillow underneath your head.

When you’re having an unbearable toothache, lying flat can cause the blood to rush to the head and mouth, which makes the pain worse.

If you sleep with your head elevated, it reduces the amount of blood rushing there. The result is less pressure and thus less pain. This may just help you get some sleep despite the aching tooth.

Call a dentist

If your tooth is hurting in the middle of the night, chances are there isn’t a single dentist open. However, what you can do is prepare yourself for the morning by coming up with a list of dentists to call as soon as 8am or 9am rolls round.

We recommend googling at least 10 different dentists that can potentially see you. Write down their information such as email and phone numbers. This way you’ll be ready to call.

Why find at least 10 dentists?

Our recommendation is to come up with at least 10 different offices because you need to be seen TODAY. There is a chance that some of them may be fully booked already and won’t be able to accomodate you.

You will search for at least ten dentists and hopefully at least one of them will have an opening for today to see you. After all, if you’re having a raging toothache, it NEEDS to be taken care of today.

We pray for your smooth sailing.

Toothache tips aren’t helping

Hopefully using all of the tips above would give you some relief from an extreme toothache but there is a chance it may not. If your condition is just too severe, all types of home treatment will not work.

If you’re not getting any relief at all and you can’t bear that toothache any longer, you may not have any other choice but to go to the emergency department (ED).

What the ED can do for you:

  • Give you stronger painkillers.
  • Rule out other causes of your pain.

What the ED can’t do for you:

  • Unfortunately, the vast majority of emergency departments at hospitals are not equipped to perform dental procedures.
  • That means if you need a tooth extracted, that won’t happen in the ED.
  • Have you ever seen a dental chair in there? You haven’t because it’s not equipped for it.
  • Ultimately, you’ll have to wait until the sun rises and then they can refer you to their dental department within the hospital.

Due to the fact that there will be no midnight dental treatments such as root canals and extractions, the hospital visit may not be as pain relieving as you may have initially hoped. That is why we presented a lot of at home tips for you so that hopefully you can bear it through the morning to see a dentist.

Did you know that dental visits to the already busy and overcrowded hospital emergency department is a burden on the healthcare system? Public health officials have been attempting to formulate a strategy to divert emergency dental visits away from the ED for years now.


If you have extreme tooth pain and can’t sleep, you definitely need to see a dentist to get permanent pain relief. However, since dentists aren’t open 24/7, we’ve provided you with multiple tips on how to alleviate the pain so that you may get some sleep.

Alternatively, if the pain is bad enough you may be forced to go to the emergency room. However, they may not be able to get you out of pain as you may expect since they aren’t equipped with dental equipment.

Studies have shown that dental emergencies over burden the hospital. Therefore, an additional goal of our article is to help alleviate some of that burden by offering you an alternative in what to do if your tooth hurts.

Really, the best thing to do is to see your dentist and hopefully you can bear it through to the morning!


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Long Island City, NY 11101

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Our purpose at afterva, is to encourage you to seek in person care with a doctor. It's not meant to be a substitute for medical advice.

A lot of nuances cannot be detected without an in-person clinical exam, which means it is near impossible to diagnose and treat virtually.

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