In multivariate analysis, it was found that the education level of the mother and father was significantly associated with oral hygiene and gingival disease. This could be explained by the findings from a study on DS children in Saudi Arabia which revealed that a higher percentage of children of illiterate mothers used water only as a method of cleaning their teeth compared to other children, and this could influence the oral hygiene status.[11] Moreover, a high correlation between poor oral hygiene and development of periodontal disease has been well documented and the role of poor oral hygiene as a risk factor of periodontal diseases is well established.[23]