In the next ten minutes
Take your usual painkiller, properly
Whichever over-the-counter painkiller you normally take, at the dose on the packet. Take it with water and food if the packet says so. Do not double it because it did not work last time, and never put an aspirin against the gum: it burns the tissue and does nothing for the tooth.
Cold on the cheek, not on the tooth
A cold compress held against the outside of the face for ten minutes at a time. Cold applied directly to an exposed nerve usually makes it worse, so keep it outside the skin.
Sleep propped up
Two pillows, or a chair if that is what it takes. This is the single change that most often buys people a few hours, and the reason is below.
Nothing very hot or very cold to drink
Both provoke an inflamed nerve. Room temperature water only, for now.
Call and describe it
The line is answered by the dentist, not a reception desk. He will tell you whether you need to come in now or can safely sleep. Both answers happen.
Why it is worse at night
This is not your imagination and it is not you being dramatic in the dark. When you lie flat, more blood reaches your head. Inside a tooth the nerve sits in a sealed chamber of hard enamel and dentine with nowhere to expand, so the extra pressure has no outlet and presses directly on an already inflamed nerve. That is why the pain arrives, or doubles, the moment your head goes down.
Two smaller things add to it. There is nothing to distract you at one in the morning, so the pain has your full attention. And most people take their last painkiller in the evening, so by the small hours it is wearing off exactly as the pressure rises.
What the pain is telling you
Sharp on cold, gone in seconds
Usually a sensitive or newly exposed surface. Uncomfortable, not urgent. This one can generally wait for a normal appointment.
Throbbing, keeps you awake, worse lying down
The nerve inside the tooth is inflamed or infected. This is the classic night presentation and it does not settle on its own. It needs treating, and the sooner it is treated the more of the tooth is saved.
Pain plus swelling in the face or gum
An infection that has spread beyond the tooth. This is the one symptom that should never wait for morning, whatever the hour. Call now.
Pain when you bite down on it
Often a crack, or infection at the root tip. It will not resolve by resting the tooth, and chewing on the other side only postpones it.
What happens if you come in
You are given a time on the phone and the clinic in Barsha Heights is opened for you, so you are not sitting in a corridor behind another patient. A digital X-ray and an examination find what is actually causing it. You are shown the image, told in plain language what is wrong and what it costs, and then it is treated.
For a nerve that is inflamed but not yet infected, that is often a dressing that settles it the same night. For a nerve that has died, it is usually the first stage of a root canal. Either way you leave without the pain, and the rest is planned properly for later rather than rushed at three in the morning.
Most emergency patients are in the chair within the hour of calling. The prices are published in advance.