Toothache Causes Guide: From Cavities, Gums and Cracked Teeth to Sinuses and the Heart

Causes of toothache fall broadly into problems of the tooth itself and problems outside the tooth. Pain worsens when decay reaches the nerve or the root tip becomes inflamed, and problems of the jaw muscles, sinuses or heart can also make a tooth feel painful. Depending on the cause, dental treatment is sometimes not needed, so an accurate diagnosis comes first.

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

Key facts

Odontogenic causes	Dentin hypersensitivity, pulpitis, periodontitis, tooth fracture (source: Korea Disease Control and Prevention Agency (KDCA, 질병관리청) National Health Information Portal)
Non-odontogenic causes	Muscular, neurovascular, cardiac, trigeminal neuralgia, sinus, psychogenic (source: Korea Disease Control and Prevention Agency (KDCA) National Health Information Portal)
Stage of decay and pain	Enamel only is almost painless; dentin is sensitive to cold and sweet; reaching the nerve causes unbearable pain (source: Korea Disease Control and Prevention Agency (KDCA) National Health Information Portal)
Causes of sensitivity	Incorrect brushing, poor oral hygiene, periodontal and restorative treatment, acidic food, excessive biting force, decay, tooth cracks (source: Korea Disease Control and Prevention Agency (KDCA) National Health Information Portal)

What toothaches come from a problem in the tooth itself?

The KDCA National Health Information Portal lists four causes of odontogenic toothache, which arises from an abnormality in the tooth. The nature of the pain differs for each, which helps in describing symptoms during a visit.

Among these, with pulpitis it is hard to point exactly to the causative tooth, while with acute periodontitis at the root tip people can usually find the painful tooth. A vague pain location does not mean it is not a tooth problem.

Dentin hypersensitivity: sensitive to cold water, cold air and scratching, and the symptom disappears when the stimulus is gone.
Pulpitis: dull or aching pain with a pulse-like feeling, which in severe cases wakes you at night.
Periodontitis: the chronic form has mild pain and is easy to overlook, while acute inflammation at the root tip worsens on biting and gives a feeling that the tooth is raised.
Cracked tooth: sharp pain on biting that soon disappears when force is released, and sometimes it hurts more when you let go.

At what stage does decay start to hurt?

The KDCA explains that when decay is only in the outermost layer, the enamel, almost no pain is felt. Not hurting does not mean there is no decay, so finding it early through regular checkups is important.

When decay progresses to the inner layer, the dentin, the tooth is sensitive to cold food and to sweet taste. When it reaches the nerve area inside the tooth, unbearable pain occurs, and this is likely the pulpitis stage, in which the nerve is inflamed.

In pulpitis, the reversible stage, in which pain disappears right after the stimulus stops, can be expected to recover with treatment that removes the decay and protects the nerve. The irreversible stage, in which it hurts even without stimulation, needs root canal treatment or extraction.

What toothaches come from outside the tooth?

There is also non-odontogenic toothache, in which the teeth are fine but feel painful. The causes and features introduced by the KDCA are as follows.

Non-odontogenic toothache does not improve even when the tooth is treated. It can instead lead to unnecessary root canal treatment or extraction, so if the dental examination shows nothing wrong, it is important to look for other causes as well.

Muscular: myofascial pain of the chewing muscles feels like toothache, and the pain is constant without pulsation.
Neurovascular: accompanies migraine, feels like a pulse, and sometimes repeats at the same time of day.
Cardiac: worse with activity, and often accompanied by chest, front-neck and shoulder pain.
Trigeminal neuralgia: brief, intense pain like an electric shock on one side of the face when washing, brushing or eating.
Sinus: upper teeth hurt with sinusitis or rhinitis and get worse when you lower your head.
Psychogenic: chronic pain that moves among several places and does not respond to dental treatment.

Which department should I visit depending on the cause?

At first, it is in order to have the dentist check for tooth and gum problems. Odontogenic toothache is resolved at the dental clinic by cavity treatment, root canal treatment, gum treatment, extraction and so on.

If the dental examination shows nothing wrong, the department differs by symptom. Sinus toothache is treated by an otolaryngologist for sinusitis or rhinitis, and neurovascular toothache can disappear with migraine treatment. Trigeminal neuralgia is relieved with medication prescribed by a specialist.

If cardiac toothache is suspected, an examination by a cardiologist should be done right away. If pain repeats although various tests show nothing wrong, the KDCA recommends an evaluation in psychiatry.

What should I avoid before the cause is known?

Avoid getting by on painkillers alone. According to the KDCA, some people judge by themselves when a wisdom tooth hurts and live on anti-inflammatory painkillers alone until the inflammation grows into an emergency.

Also be careful about insisting that the tooth on the painful side be treated before the cause is confirmed. If pain unrelated to the teeth, such as trigeminal neuralgia, is mistaken for a tooth problem, you may receive unnecessary treatment.

Rather than moving from hospital to hospital out of anxiety, narrowing down the cause at one place on the basis of test results helps the diagnosis.

Common myths and facts

Myth: All toothaches are caused by cavities.

There are other dental problems such as gum inflammation, cracked teeth and dentin hypersensitivity, and causes outside the tooth such as muscles, sinuses, heart and nerves.

Myth: If a tooth hurts, pulling it solves the problem.

Non-odontogenic toothache does not need dental treatment, and care is needed not to receive unnecessary treatment after trigeminal neuralgia is misdiagnosed as a tooth problem.

Frequently asked questions

My tooth tingles when I eat something sweet. What causes it?

When decay progresses to the dentin, the tooth can become sensitive to sweet taste. If it hurts sharply with a stimulus like sugar water and then goes away right away, it may be reversible pulpitis, and treatment at this stage has a good chance of saving the nerve.

My upper teeth hurt and I feel like I have a cold. Is there a link?

With sinusitis or rhinitis, sinus toothache, in which pain is felt in the upper teeth, can occur. If it worsens when you lower your head or walk heavily, it can be suspected, and the dentist also checks whether there is anything wrong with the teeth.

Is a stiff jaw with tooth pain also toothache?

It may be muscular toothache, in which myofascial pain of the chewing muscles feels like toothache. It is characterized by constant pain without pulsation that worsens when the muscle is pressed, and it improves with myofascial pain treatment without dental treatment.

Several teeth hurt in turn and treatment does not help.

Pain that moves among several places and does not respond to dental treatment is introduced as a feature of psychogenic toothache. If it repeats even after other causes have been thoroughly checked, it is good to have an evaluation in psychiatry.

How do I tell gum pain from tooth pain?

When gum inflammation deepens and spreads to the root tip, the tooth itself feels painful and the pain grows when chewing. It is hard to tell by yourself, so remember whether gum bleeding or swelling are also present and tell the dentist at the visit. Chronic periodontitis has mild pain and is easy to leave untreated too long, so regular checkups are advisable even if nothing hurts.

References

Korean version →