Objective: To verify the prevalence of toothache and its relationship with dental caries experience and treatment needs among schoolchildren aged 12 in the city of Paulínia, S o Paulo, Brazil.Methods: The 413 schoolchildren chosen to participate in this survey were selected by systematic random sampling from public schools and were examined in 2004. The subjects answered a questionnaire and underwent an oral exam. For the statistical analysis, the Mann-Whitney and Chi-squared tests were used. Results: Prevalence of toothache was 22.8% and the DFMT was 0.9 (IC=0.8-1.1). The students that presented toothache showed a higher DFMT index and percentage of decayed teeth than the group that did not report pain (p <0.05). Moreover, schoolchildren who reported toothache had a higher percentage of teeth with restorative treatment needs (p=0.033). The most prevalent treatment needs were restorations in 2 or more surfaces (p=0.017). Conclusion: Although this city presented very low caries experience, a considerable percentage of the adolescents reported having toothache (22.8%), The group with toothache had the worst oral health conditions. Furthermore, in this same group, there were more absences from school and a negative impact on satisfaction with the appearance of the teeth.