The aim was to assess the influence of culture on pain expression, pressure pain thresholds (PPTs), and pain tolerance levels (PTLs) in temporomandibular disorders (TMD) pain cases and pain-free matched controls in three cultures. Methods: This was a case-controlled study on 150 (50 Saudi Arabians, 50 Italians and 50 Swedes) cases of chronic TMD pain compared with 148 age- and gender-matched pain-free controls (50 Saudi Arabians, 50 Italians, and 48 Swedes). The cases and controls completed pain questionnaires and underwent clinical examinations per the Research Diagnostic Criteria for TMD (RDC/TMD) for classification status. PPT and PTL were measured on all participants with a pressure algometer (Somedic®) at a pressure increase rate of 30 kPa/s using a 1.0-cm diameter probe. Three body sites on the right side were investigated: the temporalis, masseter, and thenar muscles. The average of three measurements made at 1-min intervals was calculated for PPT and PTL. A one-way ANOVA compared mean values. Results: Mean characteristic pain severity among TMD cases was 54±(25) for the Saudi Arabian; 56±(20) for the Swedish; and 62.5±(21) for the Italian cases. Between-culture differences were non-significant. PPTs at the temporalis and masseter muscles in the TMD cases were highest in the Saudi Arabians compared to the Swedes and Italians (P<0.001). No between-culture differences among the TMD cases were found in the thenar muscle. Among controls, higher PPTs in the masseter muscle were found in Swedes and Saudi Arabians compared with Italians (P<0.001), while Swedes reported the highest PPT for the thenar compared with Saudi Arabians and Italians (P<0.001). No between-culture differences were observed at the temporalis muscle. PTLs at the masseter muscle in the TMD cases were similar for the Saudi Arabians and Swedes but significantly lower for the Italians (P<0.001). Thenar PTLs were significantly higher in the Swedes compared to the Italians (P<0.001). No significant between-culture differences among the TMD cases were found in the temporalis muscle. Among controls, similar PTLs were observed in the Swedes and Saudi Arabians for the temporalis and masseter muscles, while the Italians had significantly lower PTLs than these groups at the masseter muscles (P<0.01) and lower than the Swedes at the temporalis (P<0.001). A significantly higher thenar PTL was found among Swedes compared to Saudi Arabians and Italians (P<0.001). Cross-modality PPT based on clinical pain for TMD cases revealed significant differences between Saudi Arabians and both Swedes and Italians in the temporalis and masseter muscles (P<0.001). No significant differences were found in the thenar muscle. Conclusions: Preliminary data suggest that Saudis and Swedes are more similar in PPT and PTL than Italians are to either group, indicating that cultural factors may influence pain perception.