OBJECTIVE: This systematic review and meta-analysis aimed to assess the association between the dental caries and the level of salivary alpha amylase activity among caries active and caries free individuals. DESIGN: This review followed the PRISMA guidelines and registered in PROSPERO (CRD42024518973). A comprehensive search across various research databases until January 31, 2024 yielded 1031 articles, where multiple screening ultimately narrowed it to 13 articles. Appropriate cross sectional studies comparing caries active (CA), caries free (CF) group and evaluating their level of salivary alpha amylase activity were included. RESULTS: The meta-analysis was performed on all 13 included studies utilizing a random effects model and two sub group analysis were performed where studies with salivary alpha amylase activity estimated using spectrophotometer and autoanalyzer were analyzed separately among caries active and caries free group. The pooled data reveals that the salivary alpha amylase activity was significantly higher (p = 0.005) in caries active group compared to caries free group with a standardized mean difference of 1.30. CONCLUSION: This review indicated the differences in the salivary alpha amylase activity among caries active and caries free individuals which could aid in identifying individuals susceptible to dental caries thereby offering new insights for preventive dentistry by assessing their caries risk, enabling tailored preventive strategies.