A toothache that prevents you from sleeping may require opening the pulp, cutting open the abscess, or extracting the affected tooth, etc. It is recommended that you go to the hospital for timely consultation. 1. Pulpitis can present with the symptom of a toothache that prevents you from sleeping. Usually painkillers have little effect, and the tooth needs to be drilled open to release the pressure of the blood in the pulp cavity, or the pus may need to be drained out to relieve the pain. This is followed by root canal treatment. 2. Severe abscesses can and do hurt so much that you can’t sleep. It is recommended that fluctuating abscesses can be incised and drained in the hospital to reduce the pain. After the acute stage is over, we can consider periodontal treatment, root canal treatment or extraction. 3. Fractured teeth may be painful, usually need to extract the broken part, the remaining can be treated and retained to do treatment and then restoration, can not be treated is recommended to be extracted.