Purpose <p>To review the current evidence on the association of breastfeeding during the first years of life with the development of Early Childhood Caries (ECC<b>).</b></p> Materials and methods <p>A systematic review of literature was conducted in June 2019 and again in March 2024 at the following Databases: Pub Med, Scopus, Cochrane Library, Science Direct, Google Scholar, for studies reporting on children aged up to 71 months investigating breastfeeding duration/cessation and presence of caries at the examination. Prospective Cohort studies were included in the review. The systematic review was conducted according to PRISMA statement guidelines.</p> Results <p>Of the 4894 papers identified, the data extraction protocol led to 8 studies for further review. Assessment of Risk of Bias was made using the ROBINS-E tool. Six studies were characterized as high risk of bias, one characterized with some concerns and one with low risk of bias. Breastfeeding for 6–12 months has a protective effect against ECC. There is no association between breastfeeding and ECC for the ages 12–24 months; however, depending on the frequency or when combined with increased sugar consumption, it can have an impact on dental caries prevalence. Beyond 24 months, breastfeeding was associated with increased ECC prevalence.</p> Conclusions <p>Based on the studies included in this review and within their limitations, breastfeeding up to 2 years of age does not increase ECC risk, but after 2 years of age breastfeeding is associated with increased risk of ECC.</p> Trial registration number <p>The protocol for this systematic review was registered on PROSPERO (CRD42020179773).</p>