Early Childhood Caries (ECC) remains a global public health challenge, particularly in underserved populations where access to conventional dental care is limited. Silver Diamine Fluoride (SDF) has emerged as a transformative approach in the management of ECC, offering a minimally invasive, cost-effective solution to arrest caries progression and prevent new lesions. This review provides a comprehensive evaluation of SDF, focusing on its mechanism of action, clinical efficacy, advantages, and limitations in pediatric dentistry. Evidence from recent studies demonstrates that SDF is highly effective in halting caries progression, significantly reducing the need for more invasive treatments, particularly in young or uncooperative patients. However, aesthetic concerns, primarily the black staining of treated lesions, and the need for informed parental consent remain key barriers to its widespread adoption. The article also explores the integration of SDF into broader public health strategies for ECC prevention and treatment, emphasizing its role in resource-constrained settings. Ethical and legal considerations, along with future research directions, are discussed to address gaps in understanding its long-term safety and efficacy. By advancing the use of SDF, this review highlights its potential to revolutionize the management of ECC, aligning with global goals of equitable access to essential health care.