Comparative assessment of oral hygiene awareness and periodontal knowledge among caregivers of children with and without intellectual disabilities: a cross-sectional comparative study

OBJECTIVES: Individuals with intellectual disabilities (ID) experience disproportionately higher rates of periodontal disease. While biological vulnerability contributes, the oral health knowledge and awareness of primary caregivers is increasingly recognized as a critical modifiable determinant. This study aimed to explore potential differences in the periodontal knowledge, oral hygiene awareness, personal hygiene practices, and child-directed supervision behaviors of caregivers of children with ID versus caregivers of neurotypical children. METHODS: A cross-sectional comparative study was conducted among 402 parents in Kocaeli, Türkiye (201 in each group). Caregivers of children with ID (aged 6-12) were recruited from special education centers, while controls were recruited from a university dental clinic. A structured, interviewer-administered questionnaire assessed four domains: sociodemographic characteristics, periodontal knowledge (17 items), personal oral hygiene behaviors (10 items), and child-directed oral care supervision practices (5 items). Between-group comparisons were performed using Pearson's Chi-square test (with Cramér's V as effect size measure), Student's t-test, and Mann-Whitney U test (α = 0.05). RESULTS: The ID group demonstrated significantly lower educational attainment and household income (p < 0.001). A pronounced disparity in periodontal knowledge was observed across the majority of knowledge items (14 of 17 items at p < 0.001; Cramér's V range: 0.06-0.36). Only 39.3% of the ID group correctly defined periodontitis versus 75.1% of controls. Notably, 56.2% of the ID group did not correctly identify gingival bleeding as a pathological sign. Regarding personal habits, twice-daily brushing was reported by 50.7% of the ID group compared with 75.1% of controls (p = 0.001). In child-directed care, only 20.4% of ID-group caregivers actively brushed their child's teeth, with "verbal reminding" being the predominant strategy (31.3%) despite its limited efficacy in this population. After adjustment for maternal education, household income, and marital status, group membership remained an independent predictor of knowledge for 14 of 17 items (adjusted OR range: 1.54-8.62). CONCLUSIONS: A critical deficit in oral health knowledge and awareness exists among caregivers of children with ID, compounded by socioeconomic disadvantage. The failure to recognize gingival bleeding as pathological and the reliance on passive supervision strategies represent modifiable barriers. These findings suggest that public health interventions could benefit from caregiver-centered education that may emphasize assisted brushing techniques, early recognition of periodontal signs, and the importance of primary dentition. However, these results should be interpreted with caution given the cross-sectional design and differences in recruitment settings between the groups. CLINICAL SIGNIFICANCE: The widespread misconception that gingival bleeding is a benign consequence of "hard brushing" leads caregivers to reduce oral hygiene efforts, paradoxically accelerating disease progression. Clinicians should incorporate structured caregiver education into routine appointments, with particular emphasis on the pathological significance of bleeding on probing.