Pain arising for the teeth and supporting structures is a very common complaint, affecting around 9% of adults in the UK, and it can sometimes be difficult to determine the exact cause. In this narrative review, we explore the underlying neurophysiology of odontogenic pain and describe the relevance of this to clinical practise. We discuss characteristic features of pain arising from the various dentoalveolar structures and common oral disorders, and consider that nonodontogenic pain may occasionally present as toothache. As well as describing current approaches to reaching a reliable diagnosis, we also discuss some innovative techniques and potential future developments in this area.