Background <p>Excessive sugar consumption is a well-established risk factor for dental caries, particularly in pediatric populations. This systematic review explores the relationship between sugar consumption and the development of dental caries in children and adolescents.</p> Methods <p>This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was prospectively registered (PROSPERO, CRD420250619741). A comprehensive search of PubMed, Web of Science, Scopus, Embase, and SciELO was performed. Observational studies involving children and adolescents (≤ 18 years) that assessed sugar consumption and dental caries using validated indices (e.g. DMFT/dmft) were included. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Data were extracted using a standardized form and synthesized qualitatively.</p> Results <p>A total of 37 studies (34 cross-sectional and 3 longitudinal) met the inclusion criteria. These studies were conducted across diverse regions and encompassed 59,383 participants aged 2 to 18 years. Of these, 32 (86%) reported a statistically significant positive association between sugar consumption and dental caries. The mean DMFT/dmft scores across the included studies ranged from 0.39 to 6.47, with higher values being consistently associated with increased sugar consumption. The evidence consistently indicated that the frequency of sugar consumption was a stronger determinant of caries development than the total quantity consumed.</p> Conclusions <p>Evidence suggests that the frequency with which sugar is consumed is consistently associated with an increased prevalence and severity of dental caries in children and adolescents. Public health strategies should prioritize reducing consumption frequency through evidence-based dietary guidelines and targeted, school-based interventions.</p>