This study examined the hypothesis that age-matched siblings with and without Down syndrome (DS) have the same risk of ever having had a tooth restored. A sibling-matched, population-based, cross-sectional survey design was used with the help of the Canadian Down Syndrome Society whose members were the sample source. The relationship between DS status and restorative status was evaluated using conditional multiple logistic regression with matching by sibling status and adjustment to control for sociodemographic and clinical variable. Data from 793 sibling pairs were used for the analyses. DS status was strongly related to dental restoration in that subjects with DS had reduced odds for ever having had a tooth restored (OR: 0.28; 95% CI: 0.18-0.43). An analysis of the results suggested that, controlling for age and family-related factors commonly associated with dental care, children with DS were less likely to have had a tooth restored than their sibling without DS.