Objective The aim of the present study was to assess the prevalence, treatment need of TMD pain and its possible association to socio-economic factors in adolescents of Xi’an, Shaanxi Province, China. Another aim was to compare the prevalence of TMD in Xi’an, China to an agematched Swedish population. Methodology Chinese adolescents aged 15 to 19 years were surveyed by questionnaire in Xi’an, China (n=5524). A two-staged stratified sampling with the school as sampling unit was used. Students the second year at selected high schools were included. An age-matched Swedish population was included using the same diagnostic criteria for TMD (n=17015) as was used in the Chinese sample (TMDs). Results TMD pain was found in 14.8% (n=817) and 5.1% (n=871) in the Chinese and Swedish samples, respectively (p<0.0001). Female subjects had significantly more TMD pain compared to males in both the Chinese (p<0.05) and the Swedish (p<0.001) samples. There was an increase of TMD pain with age. Of those with TMD pain, 47% of the Chinese adolescents reported a perceived need for treatment. Rural location of school, poor father’s education, poor economy, living outside home, poor general and oral health, and dissatisfaction with teeth were significantly positively correlated to TMDs. Conclusion There was an alarmingly high prevalence of TMD pain in Chinese adolescents.