Children with autism spectrum disorder frequently experience barriers in accessing oral healthcare services due to behavioral, sensory, and communication difficulties. This cross-sectional comparative study aimed to evaluate differences in dental attendance, accessibility to dental care, and treatment patterns between autistic and non-autistic children in Benghazi, Libya. The study included 60 children aged 3-14 years, comprising 30 autistic children attending rehabilitation centers and 30 healthy children selected from relatives of autistic patients. The control group was matched to the autistic group with respect to age, gender, and socioeconomic status. Data were collected through structured parent-administered questionnaires during face-to-face interviews. Information regarding dental attendance, type of dental facility, accessibility to dental care, history of dental problems, and treatment modalities was obtained. Statistical analysis was performed using Chi-square, Fisher’s exact test, Monte Carlo simulation, independent t-test, and Mann-Whitney U test, with statistical significance set at p < 0.05. The results demonstrated that autistic children were significantly less likely to have visited the dentist in the previous year than non-autistic children (26.7% vs. 50.0%, p = 0.049). Although all children received care in private clinics, parents of autistic children reported significantly greater difficulty in finding dentists willing or adequately trained to treat their children (p = 0.001). However, autistic children were more likely to undergo tooth extraction, while restorative treatments and pulp therapy were less frequently provided. These findings highlight significant disparities in access to dental care and treatment approaches among autistic children and emphasize the need for improved professional training, specialized dental services, and preventive oral healthcare programs for children with autism spectrum disorder.