When you lie down, blood pressure increases in your head, raising intrapulpal pressure in an inflamed tooth. Additionally, the distraction-free environment at night makes you more aware of pain. This pattern of worse nighttime pain strongly suggests irreversible pulpitis requiring treatment.

Ibuprofen can reduce pain temporarily by decreasing inflammation, but it cannot treat the underlying cause. If you need to manage pain before your appointment, alternating 400mg ibuprofen with 500mg acetaminophen every three hours is the most effective over-the-counter regimen according to current evidence.

We use a systematic diagnostic protocol including cold testing with refrigerant spray, percussion testing, bite stick analysis, periodontal probing, and CBCT imaging. Referred dental pain can make it feel like the wrong tooth hurts, so methodical testing is essential for accurate diagnosis.

If severe throbbing pain abruptly disappears, the nerve has likely died. This is not healing — the infection remains and will eventually form an abscess. You still need treatment, and sooner is better because the infection is now progressing without the warning signal of pain.

Yes. The trigeminal nerve serves both the teeth and much of the face and head. Referred pain from an infected or dying tooth commonly manifests as ear pain, temple headache, or pain along the jawline. We see this pattern multiple times per week.

Absolutely. Severe pain indicates active pathology that is worsening. We classify severe toothache as an emergency and offer same-day appointments. Call (503) 822-0096 and tell the receptionist your pain level — we will prioritize your scheduling accordingly.

If the pain is caused by irreversible pulpitis or a periapical abscess, root canal therapy is the standard treatment to save the tooth. Not all toothaches require root canal — some are caused by cracked teeth, gum disease, or occlusal trauma that may have different treatments.

Most patients experience dramatic pain relief within hours of root canal therapy or extraction. Some residual tenderness in the surrounding tissues is normal for two to three days, but the severe throbbing pain resolves immediately once the source is addressed.

A cavity that has penetrated through enamel and dentin to reach the pulp can absolutely cause severe pain. At that point, bacteria have infected the nerve tissue, and a simple filling is no longer sufficient — the tooth needs root canal therapy or extraction.

Many causes of severe toothache are invisible to the naked eye: hairline cracks, internal resorption, periapical abscesses, and deep interproximal decay. This is precisely why we use CBCT 3D imaging — it reveals pathology that visual examination and standard X-rays miss.

Yes. IV sedation and oral sedation are both available. Patients in severe pain often have heightened anxiety, and sedation allows us to complete treatment efficiently while keeping you completely comfortable.

Yes. Pediatric toothache is an emergency we take seriously. Children cannot always articulate their pain level, and infections in primary teeth can affect developing permanent teeth. We offer sedation options appropriate for children.

Stress itself does not cause toothache, but stress-related clenching and grinding (bruxism) can cause cracked teeth, worn enamel, and myofascial pain that mimics toothache. Accurate diagnosis requires clinical testing to differentiate muscular from dental pain.

The diagnostic visit including exam and CBCT imaging is typically $150 to $300. Treatment costs depend on the diagnosis — a root canal on a molar ranges from $1,000 to $1,500, while an extraction ranges from $200 to $800 depending on complexity. We review costs before treatment.

Take alternating ibuprofen (400mg) and acetaminophen (500mg) every three hours. Avoid hot or cold foods and beverages. Sleep with your head improved on two pillows. Do not place aspirin directly on the gum — this causes chemical burns. Call (503) 822-0096 if pain becomes unbearable.