The proven combo: ibuprofen plus acetaminophen taken together (they work differently and dental-pain trials show the pair beats either alone), a cold compress on the cheek, sleep with your head propped up, and a warm saltwater rinse. Then get a dentist tomorrow - a toothache is a symptom, not the problem.
Tonight's playbook: take ibuprofen (400 to 600mg) plus acetaminophen (500 to 1000mg) - the combination is the most effective dental pain relief studied, better than opioids in the trials; a cold compress on the outside of the cheek, 15 minutes on and off; prop your head up with an extra pillow - lying flat increases blood pressure in the head and throbbing; a warm saltwater rinse (half a teaspoon of salt in warm water) to clean the area. What not to do: no aspirin placed on the gum (it burns the tissue - an old myth that causes chemical burns), no very hot, cold, or sweet food and drink on that side, and do not put off tomorrow. Why it throbs at night: fewer distractions, lying flat, and cortisol dropping overnight all amplify it. Tomorrow: call a dentist first thing and say you are in pain - most hold same-day urgent slots; no insurance means ask the cash price (an exam and X-ray typically runs $75 to $200, and dental schools treat at steep discounts). A tooth infection does not heal itself - pain that fades can mean the nerve died while the abscess grows. Emergencies skip this list: chest pain, trouble breathing, stroke signs, severe bleeding, or thoughts of self-harm mean call 911, or 988 for a mental health crisis in the US.
What to do
Common questions
Why does tooth pain get worse at night?
Three reasons stack up: lying flat increases blood pressure to the head, which amplifies the throbbing pressure inside an inflamed tooth; cortisol - your natural anti-inflammatory - hits its daily low overnight; and there is nothing left to distract you. That is why the head-propped-up trick genuinely helps, and why the medication timing matters: take the ibuprofen-acetaminophen combo right before bed for coverage through the worst hours.
Is it safe to take ibuprofen and acetaminophen together?
Yes - they work through different mechanisms and are safe combined at labeled doses for short stretches in healthy adults (ibuprofen 400-600mg every 6 hours, acetaminophen 500-1000mg every 6 hours, respecting daily maximums of 1200mg OTC ibuprofen without guidance and 3000-4000mg acetaminophen). Dental research shows the combo outperforms either alone - and beats opioid combinations - for dental pain. Skip ibuprofen if you have kidney disease, ulcers, or are on blood thinners; acetaminophen alone then.
The toothache suddenly stopped hurting - is that good?
Not necessarily - and this is the trap. When a deep cavity infects the tooth's nerve, the pain peaks, then can go quiet when the nerve dies. The infection does not die with it: it keeps spreading into the bone as a painless (for now) abscess, which can become a facial swelling or worse. A toothache that 'resolved' still needs a dentist this week.
When is a tooth problem an emergency instead of a tomorrow problem?
Swelling of the face, jaw, or under the tongue, fever with the toothache, trouble swallowing or breathing, or swelling spreading toward the eye or neck - those mean a spreading dental infection, which can genuinely threaten the airway. That is an ER, tonight, not a dentist tomorrow. Everything short of that list survives the night with the playbook above. Emergencies skip this list: chest pain, trouble breathing, stroke signs, severe bleeding, or thoughts of self-harm mean call 911, or 988 for a mental health crisis in the US.