Toothache Causes and What to Do: Telling Pain From the Teeth Apart From Pain From Elsewhere

Toothache is divided into odontogenic toothache, whose cause lies in the tooth, and non-odontogenic toothache, in which the teeth are fine but a muscle, sinus, heart or nerve problem makes the tooth feel painful. The suspected cause differs depending on whether it hurts briefly with cold, throbs even at rest, or hurts when chewing. Painkillers only reduce pain and do not treat the cause, so a dental examination is needed.

Published 2026-11-08 · Updated 2026-11-08 · DentalStatics editorial team

Key facts

Classification of toothache	Odontogenic toothache from a tooth problem; non-odontogenic toothache from other causes (source: Korea Disease Control and Prevention Agency (KDCA, 질병관리청) National Health Information Portal)
Main causes of odontogenic toothache	Dentin hypersensitivity, pulpitis, periodontitis, cracked tooth (source: Korea Disease Control and Prevention Agency (KDCA) National Health Information Portal)
Experience of sensitivity	8-57% of adults experience hypersensitivity (source: Korea Disease Control and Prevention Agency (KDCA) National Health Information Portal)
Adult acetaminophen dose	0.5-1.0 g per dose, 3-4 times a day, maximum 4 g a day (source: Ministry of Food and Drug Safety (MFDS, 식품의약품안전처))
Self-medication period for painkillers	Do not take for pain for 10 days in adults or 5 days in children without a doctor's or pharmacist's instruction (source: Ministry of Food and Drug Safety (MFDS))
Visits for root canal treatment	Usually 3-4 or more visits at intervals of 3-7 days (source: Korea Disease Control and Prevention Agency (KDCA) National Health Information Portal)
Finding open facilities on holidays	Emergency Medical Portal (e-gen), Health and Welfare Counseling Center 129, city and provincial call center 120 (source: Ministry of Health and Welfare)

How is toothache classified?

The KDCA National Health Information Portal divides pain caused by a problem in the tooth into odontogenic toothache, and pain in which the tooth is fine but feels painful because of another cause into non-odontogenic toothache. Most is odontogenic, but if pain stays the same even after the tooth is treated, a non-odontogenic cause is suspected.

Typical causes of odontogenic toothache are dentin hypersensitivity, pulpitis, periodontitis and a cracked tooth. Non-odontogenic toothache includes muscular toothache from the jaw muscles, neurovascular toothache accompanying migraine, cardiac toothache related to angina or myocardial infarction, trigeminal neuralgia, toothache from sinusitis, and psychogenic toothache for which a cause is hard to find.

What matters about non-odontogenic toothache is that it does not get better when the tooth is treated. The KDCA advises being careful not to misdiagnose trigeminal neuralgia as a dental problem and receive unnecessary dental treatment, and explains that cardiac toothache can sometimes appear as toothache alone, so caution is needed.

Can the cause be guessed from the pain pattern?

The feel of the pain and the situations in which it appears are important clues for narrowing down the cause. However, the same pattern can overlap across several causes, so the list below is a reference for organizing symptoms before a visit.

Decay causes little pain while it is only in enamel, but once it reaches dentin the tooth becomes sensitive to cold food and sweet taste, and when it reaches the nerve area, pain that is hard to bear occurs.

Brief sensitivity to cold water or cold air that soon disappears when the stimulus is gone: dentin hypersensitivity or reversible pulpitis
Pain that continues even after the stimulus stops, or is bad enough to wake you at night: irreversible pulpitis
Worse on biting, a feeling that the tooth is raised, and you can point exactly to the painful tooth: acute periodontitis around the root tip
Sharp pain on biting, sometimes worse when you release the force: cracked tooth
Upper teeth hurt more when you bend your head down or walk heavily: sinus toothache
Worse with activity, accompanied by chest, front-neck or shoulder pain: cardiac toothache

How does the dentist find the cause?

The dentist first asks since when, with what stimulus and for how long it hurts, then examines the mouth. The tooth is lightly tapped to see the response, tests show how the nerve reacts to cold, heat and electrical stimulation, and X-rays check the depth of decay and inflammation at the root tip.

With pulpitis, patients often cannot point exactly to the causative tooth, while with periodontitis at the root tip they can usually find the painful tooth. If the tests show nothing wrong with the teeth, the dentist looks at causes in the jaw muscles, sinuses, nerves or heart and, if needed, refers to another department.

Taking notes on the following before the visit helps in finding the cause.

The day the pain first began and the time of day it is worst
Which stimulus hurts: cold, hot, sweet or chewing
How much pain remains after the stimulus is gone
Whether swelling, pus, fever, headache, stuffy nose or chest pain are also present
The name and amount of any painkiller taken, and other medicines you take

How does treatment of toothache differ by cause?

For dentin hypersensitivity, stimulation is reduced and fluoride application or laser treatment is done, and fundamentally the exposed dentin is covered. For reversible pulpitis, the decay is removed and the nerve protected, with a permanent restoration weeks later, and irreversible pulpitis needs root canal treatment or extraction.

Inflammation that has spread to the root tip is eliminated at the source with root canal treatment, with antibiotics if there is heat and incision and drainage if there is pus. A vertically fractured tooth is usually extracted. When the tooth is not the cause, as with muscular, neurovascular, cardiac or sinus toothache, the relevant disease is treated without treating the tooth.

Root canal treatment usually takes 3-4 or more visits at intervals of 3-7 days, and because the tooth is weakened afterward, molars are often protected with a crown.

How should I take painkillers for a toothache?

The Ministry of Food and Drug Safety (MFDS) advises that single-ingredient acetaminophen can be taken by adults at 0.5-1.0 g per dose, 3-4 times a day, up to 4 g a day. The same ingredient may be in cold medicines and other products, so take only one acetaminophen-containing medicine at a time.

Nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen and aspirin calm inflammation but carry a risk of gastrointestinal bleeding. If you drink 3 or more drinks every day, have liver disease or take warfarin, consult a doctor or pharmacist before taking a painkiller. Adults should not take them for pain for 10 days or more without a doctor's or pharmacist's instruction.

For children, use a product made for children matched to age and weight, and do not give it for pain for 5 days or more without a doctor's or pharmacist's instruction. If it is not effective enough, it is safer to bring the visit forward than to increase the dose.

Which toothaches need care right away?

The KDCA advises seeing a dentist right away if the face is badly swollen and the mouth does not open well, or if swallowing is difficult and the throat hurts with chills and fever. This is because repeated inflammation can become severe enough to swell the face and neck.

If chest, front-neck or shoulder pain comes with the toothache, or pain gets worse with activity, it may be a heart problem and a cardiac examination should be done immediately. If breathing is hard or chest pain is severe, call 119 for help.

At night or during holidays, you can find open hospitals, clinics and pharmacies through the Emergency Medical Portal e-gen, the Health and Welfare Counseling Center 129, or the city and provincial call center 120.

What can I do until I get to the dentist?

Do not chew on the painful side, and avoid things that shock the tooth, such as ice or hard food. If you have sensitivity, use a soft toothbrush and sensitivity toothpaste, and cut down on acidic foods such as carbonated drinks and sour fruit.

If muscular toothache from tight jaw muscles is suspected, warm compresses, relaxation and good posture help. If the temporary filling of a tooth under root canal treatment has come out, contact the dentist right away to prevent contamination.

Do not put off treatment because the pain has lessened. When the nerve dies, the pain can ease on its own within days, but without treatment the inflammation can spread through the root tip to the surrounding bone and progress to conditions such as osteomyelitis.

Detailed guides

Frequently asked questions

If the toothache suddenly disappeared, do I not need treatment?

No. When nerve necrosis progresses in irreversible pulpitis, the pain sometimes lessens on its own within days. The KDCA explains that without treatment the inflammation can spread even when the pain is gone, so the causative tooth must be checked at the dental clinic.

The dentist says there is nothing wrong with my teeth, but it still hurts.

It may be non-odontogenic toothache. Jaw muscle pain, migraine, trigeminal neuralgia, sinusitis and heart problems can make teeth feel painful. Find the department that fits the symptoms, and be careful not to receive unnecessary dental treatment before the cause is confirmed.

I cannot tell which tooth hurts. Is that normal?

With pulpitis patients often cannot point exactly to the causative tooth, and the pain can spread to the ear or cheek. However, it characteristically does not cross the midline of the face. The dentist finds the causative tooth with tapping tests, temperature and electrical stimulation tests, and X-rays.

Which painkiller can I take for a toothache during pregnancy?

Among the various fever reducers and painkillers, the MFDS identifies acetaminophen as the ingredient that can be used relatively safely during pregnancy. Even so, consult a doctor or pharmacist before taking it, and tell the dentist you are pregnant so you can decide the timing and method of treatment together.

Where do I go if a toothache is severe at night or on a holiday?

You can find open dental clinics and pharmacies through the Emergency Medical Portal e-gen, 129 or 120. Call ahead to confirm they are seeing patients. If the face and neck are swollen and swallowing or breathing is difficult, do not wait; go to the emergency room.

Can I drink alcohol when I have a toothache?

It is better to avoid it. The MFDS warns that for people who drink 3 or more drinks every day, taking acetaminophen raises the risk of liver damage, and drinking alcohol while taking anti-inflammatory painkillers raises the risk of gastrointestinal bleeding.

References

Korean version →