Dentists' perceptions and management of the pain experienced by children during treatment were examined in surveys of 198 American and 230 Finnish dentists. Two pain management areas were studied: communication and the use of anaesthetics and sedation. Neither group of dentists routinely questioned children about pain, but encouraging the child to report pain during treatment was more common; the USA dentists asked about pain more often than the Finnish dentists, whereas the Finnish dentists more often encouraged children to report pain. Finnish dentists were much less likely to use local anaesthetics during restorative treatment of either primary or permanent teeth than USA dentists. Neither group of dentists routinely prescribed nitrous oxide sedation, or premedication, or post-operative pain medications. Regarding the dentists' perceptions of pain experienced by children during dental treatment, neither group rated dental treatment procedures as particularly painful or unpleasant. Most dentists found the pain reports of children credible, yet a sizeable minority (up to 67% of the USA dentists and 21% of the Finnish dentists) did not find them strongly credible. There was little relationship between the dentists' pain management behaviour and their perceptions of the pain experienced by their patients.