Diffusion MRI experimental design optimization for microstructure imaging.

Periodontal diseases are chronic, multifactorial inflammatory conditions initiated by the accumulation of dental plaque biofilm and propagated by the dysregulated host immune response [, ]. While largely preventable through effective plaque control and regular professional care, periodontitis remains a major global public health burden, affecting approximately 19% of the world’s adult population in its severe form []. Beyond the oral cavity, periodontal inflammation has been linked to adverse systemic outcomes, including cardiovascular disease, diabetes mellitus, and adverse pregnancy outcomes []. In pediatric populations, while destructive periodontitis is less prevalent, plaque-induced gingivitis is nearly ubiquitous and constitutes the primary precursor for future periodontal attachment loss [, ]. Individuals with intellectual disabilities (ID) bear a disproportionate burden of oral disease. Systematic reviews have consistently documented higher plaque accumulation, increased gingival inflammation, elevated caries experience, and poorer overall periodontal status in children and adolescents with ID compared to their neurotypical peers [–]. Historically, these disparities were attributed predominantly to intrinsic biological factors, including drug-induced gingival overgrowth (e.g., from antiepileptic medications), craniofacial anomalies, malocclusion, and immunological deficits associated with conditions such as Down syndrome [, ]. However, contemporary frameworks increasingly emphasize the primacy of behavioral, environmental, and socioeconomic determinants [, ]. Children with ID frequently lack the manual dexterity, cognitive processing, and executive functioning required for effective self-performed plaque control []. Consequently, the practical responsibility for their oral health resides almost entirely with their parents or primary caregivers. The caregiver’s role is multifaceted: it encompasses not only securing access to professional dental services but also the daily execution or active supervision of oral hygiene routines, dietary management, and recognition of early pathological signs []. Therefore, the caregiver’s own oral health knowledge emerges as a critical and modifiable predictor of the child’s oral health outcomes []. Because the success of daily oral care and disease prevention depends directly on the caregiver’s understanding of these practices, their level of oral health knowledge is fundamental to maintaining the child’s well-being. Recognizing this vital connection, the present study specifically aims to assess the oral health knowledge and awareness levels of these primary caregivers.