This systematic review and meta-analysis aimed to assess and compare the prevalence of dental caries in children and adolescents with and without ASD and identify associated factors. Following the PRISMA guidelines, a comprehensive literature search was conducted across multiple databases, yielding 2,103 studies, from which 25 met inclusion criteria. The primary outcome measure was caries prevalence, analyzed through clinical assessments. Risk of bias was evaluated using an adapted Newcastle-Ottawa Scale. Statistical analysis was performed with Review Manager, using random-effects models to account for heterogeneity, which was assessed with I2. Meta-analyses revealed no significant differences between groups for most caries indicators, such as DMFT and dmft indices. However, the mean Caries Per Surface (DMFS) index was significantly higher in ASD patients, suggesting greater caries severity. Our study found a significant difference in dental caries severity between children and adolescents with Autism Spectrum Disorder (ASD) and those without ASD, through the DMFS index.