Communication patterns with persons outside the health care system during a pain episode are poorly understood, yet can have a significant influence on patient behavior. This study examined associations between attitudes and beliefs about oral disease and dental care and talking about orofacial pain with laypersons and health care professionals. The subjects were 724 participants in the Florida Dental Care Study, a longitudinal study of oral health among community-dwelling adults. This study used a prospective design with data collected at baseline and the 42-month follow-up using a standardized interview format. Persons with negative attitudes and beliefs were more likely to have talked to a layperson about pain and less likely to have talked to a health care provider. In addition, the attitude that most consistently differentiated between respondents who had communicated only with a layperson from those who had talked to a health care provider was quality of recent visits, a variable representing more of the interpersonal aspects of a health care visit than the eventual outcomes from the treatment received. Our data are consistent with the hypothesis that lay consultation during a pain episode may substitute for formal care for persons with less positive views of the health care system. Intensity ratings and temporal characteristics of pain were also important determinants of these pain-related communication patterns. These findings emphasize the importance of understanding the communication between persons with pain and non-health care professionals, and how these attitudes and communication preferences relate to the management of pain. © 2003 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.