Background: Early Childhood Caries (ECC) poses a global public health challenge, affecting children in low socioeconomic communities. ECC impacts physical and cognitive development, necessitating advanced dental care, but preventive measures are crucial due to associated costs. Aim: Evaluate the effectiveness of Atraumatic Restorative Treatment (ART) vs. Silver Diamine Fluoride (SDF) in pediatric dental caries care. Methods: A 2-arm trial with 47 preschoolers assessed SDF and ART for untreated carious lesions. Data included initial assessments, oral health impact interviews, and clinical evaluations over 12 months, focusing on caries arrests. Secondary outcomes encompassed treatment duration, adverse events, anxiety, aesthetics, and Oral Health-Related Quality of Life (OHRQoL). Results: Both groups showed similar demographics, oral hygiene, and caries prevalence. No significant differences were observed in dmft scores, tooth distribution, or ICDAS classification. ART had more bad taste incidents, while SDF reported increased pain/sensitivity and pigmentation. Caregiver experiences werecomparable. ART and SDF exhibited similar impacts on OHRQoL, with comparable rates of caries arrest. Conclusion: Both SDF and ART demonstrated similar rates of dentine caries arrest. No disparities in anxiety, adverse events, or OHRQoL were noted. Due to costeffectiveness, operator skill independence, and shorter treatment duration, SDF is recommended, particularly in challenging care access situations.