Purpose: The aim of this cross-sectional study was to explore how Swedish General Dental Practitioners (GDPs) and Specialists in Paediatric Dentistry (SPDs) use pharmacological pain management, focusing on local anesthetics (LA) when treating children. Methods: 582 GDPs in southern Sweden and 137 SPDs nationwide received a questionnaire with 4 clinical scenarios covering filling therapy and tooth extractions in children. Each scenario had questions about how often the dentist would use LA and topical anesthetics, answered on a 5-point Likert-type scale (Always, Often, Sometimes, Seldom, Never). Results: The overall response rate was 48.0% (243 GDPs and 102 SPDs). Use of LA reported as Always or Often was more common in SPDs than GDPs for filling therapy in primary molars (98.0% vs. 90.9%, p = 0.019) as well as in permanent molars (99.0% vs. 91.7%, p = 0.006). GDPs who reported Always or Often using LA for filling therapy in primary teeth were younger (42.2 years vs. 49.1 years, p = 0.004) and had fewer years of experience as a dentist (14.2 years vs. 19.9 years, p = 0.016) compared with GDPs reporting less frequent use. Conclusion: There was an underuse of LA among GDPs when treating children. The reasons for refraining from LA are not fully understood, but possible contributing factors can be identified within work environment, insufficient undergraduate training and lack of organizational support and guidelines.