Background <p>Oral diseases are among the most prevalent non-communicable conditions globally, with inadequate toothbrushing contributing to high rates of dental caries and periodontal disease. International guidelines recommend brushing at least twice daily with fluoride toothpaste, yet adherence varies across regions. In Saudi Arabia, where oral disease burden is high, national data on brushing practices remain fragmented. This systematic review and meta-analysis aimed to determine the prevalence of twice-daily toothbrushing among Saudi adults.</p> Methods <p>A systematic search of PubMed, Scopus, and Web of Science was conducted up to April 2024, supplemented by manual screening of references. Observational studies reporting toothbrushing frequency among Saudi adults (≥ 18 years) were eligible. Data extraction was performed independently, and risk of bias was assessed using the Joanna Briggs Institute appraisal tool. Pooled prevalence estimates were calculated using random-effects meta-analysis, with subgroup analyses by gender and brushing duration.</p> Results <p>Twenty-nine studies (<i>n</i> = 17,734) met inclusion criteria, of which 18 studies (<i>n</i> = 11,865) contributed to the meta-analysis. The pooled prevalence of twice-daily toothbrushing was 44.6% (95% CI: 37.6–51.8%), with high heterogeneity (I² = 98.3%). Subgroup analysis revealed gender disparities, with 25.8% of females brushing twice daily compared to 12.2% of males. Data from two studies indicated that 45.3% of adults adhered to the recommended two-minute brushing duration. Funnel plot and statistical tests indicated no significant publication bias.</p> Conclusion <p>Fewer than half of Saudi adults practice twice-daily toothbrushing, with notable gender and regional disparities. These findings highlight the urgent need for targeted oral health promotion, particularly among men, and support the integration of structured awareness and prevention strategies into national health policies.</p>