Communication and behavioral difficulties may cause problems in coping with medical procedures for children with autistic spectrum disorders. Although previous studies have examined pain related to venipuncture, the response of children with autism to other medical procedures has not yet been documented. The purpose of this pilot study was to examine pain and distress experienced by children with autism during a dental cleaning procedure. We hypothesized that children with autism would demonstrate increased behavioral distress and pain during the dental procedure compared to children without autism. Nine children (5 children with a documented autism spectrum disorder), ages 7 to 11 years, 33.3% female, scheduled for a dental cleaning (without sedation) participated. Before the procedure, caregivers completed a behavioral checklist to identify the severity of the child's stereotyped behaviors, social interaction, and communication problems. All dental cleaning procedures were videotaped and later coded using a variation of the Brief Behavioral Distress Scale (BBDS), an observational measure of children's procedure-related distress. After the procedure, the caregiver completed the Non-Communicating Children's Pain Checklist- Revised (NCCPC) to assess pain. Mean pain scores during the dental procedure were indicative of pain for both groups, with children with autism demonstrating higher pain scores (M = 29.8) than children without autism (M = 10.0). Children with autism displayed more interfering distress behaviors than children without autism. Moderate associations were found between severity of autism symptoms and pain during the procedure (r=.55) and interfering distress behaviors (r=.43), with increased severity of the child's symptoms relating to increased pain and distress. Our finding that children with autistic spectrum disorders experienced significant pain and distress during dental cleaning procedures needs to be replicated in a larger sample. Interventions to decrease procedure-related pain and distress in children with autism are needed.