Introduction: Down syndrome (DS) is a common genetic disorder caused by the presence of an extra chromosome 21. Individuals with DS present with high prevalence of oral health conditions but oral health services are underutilized due to various reasons. Aim: The aim is to assess oral health status and barriers to utilization of oral health services among children with DS in Bengaluru city. Materials and Methods: A cross-sectional, comparative study was conducted among 100 DS children and compared with 100 non-DS (NDS) children in Bengaluru city. Clinical levels of oral hygiene were assessed using Oral Hygiene Index-Simplified (OHI-S) and caries according to WHO criteria (1997). Parents completed a structured questionnaire used to determine barriers to utilization of oral health services. Chi-square test, unpaired t-test, and Spearman's correlation were applied. Statistical significance was considered at P < 0.05. Results: Children with DS had a significantly higher mean OHI-S (3.05 ± 1.26) as compared to NDS children (1.65 ± 1.02) (P < 0.001). Mean decayed, missing, and filled teeth for DS and NDS group was 2.38 ± 3.41 and 0.66 ± 1.19, respectively, (P < 0.001), whereas mean Decayed, Missing, and Filled Teeth for DS and NDS group was 1.22 ± 1.63 and 1.78 ± 1.9, respectively, (P = 0.03). Mean awareness about child's dental problem was found to be significantly higher among DS group compared to NDS group. Accessibility was found to be positively correlated to dental visits among DS group (r = 0.30, P = 0.003). Conclusion: DS children had poor oral hygiene and considerable caries experience and faced certain barriers to utilization of oral health care services. Parental education as an integral component of oral health promotion programs should be introduced in special schools for better oral health.