Aims: To investigate the association in adolescents between toothache and sense of coherence (SOC), a psychosocial construct defined as a global orientation to life. Methods: A school-based cross-sectional study was carried out in 36 municipalities comprising up to 50,000 residents in southern Brazil. The target population was adolescents from 15 to 19 years of age. The sample consisted of 1,150 adolescents chosen by systematic sampling; the final adjusted analysis by Poisson regression included 1,065 individuals. Data were collected using a questionnaire, SOC scale, and the Decayed Missing Filled Teeth (DMFT) index. Results: Of the adolescents in the sample, 29.8% reported experiencing toothache in the previous 6 months. The prevalence of dental caries was 31.0%, and the DMFT index was 3.22. SOC was a significant protective factor for toothache; the prevalence ratio was 0.65 (95% confidence interval [CI] = 0.55-0.75). Girls presented 39% more toothaches than boys (95% CI = 1.15-1.68). Individuals who saw the dentist for reasons other than reviews or check-ups had a toothache prevalence that was 85% higher than their counterparts (95% CI = 1.47-2.34). Adolescents with tooth decay reported up to two times more toothache than those without tooth decay. Conclusion: The results of this study showed that a strong SOC protected against toothache. A health-promotion approach may lead to better patterns of oral health. Keywords: cross-sectional study, health of the adolescent, pain, sense of coherence, toothache