For an Organisation for Caries Research/European Federation of Conservative Dentistry consensus, this systematic review is aimed to assess the question of how to manage the caries process in the case of early childhood caries (ECC). Medline via PubMed was searched systematically regarding management of ECC. First priority was existing systematic reviews or randomized clinical trials otherwise cohort studies dealing with management of ECC, primarily with carious anterior teeth. After data extraction, the potential risk of bias was estimated depending on the study types, and the level of evidence was evaluated. Regarding management of ECC, results are presented for silver diamine fluoride (SDF, n = 5), nonoperative caries management (NOCM, n = 10), and restorative approaches (RA, n = 8) separately, as different kinds of studies with different levels of evidence were found for the different aspects in the management of ECC. The 5 systematic reviews on SDF showed a high potential for arrest of ECC on a high level of evidence. In NOCM, a low level of evidence for a moderate effect of fluoride varnish in arresting or remineralizing, especially non-cavitated lesions, was assessed. For RA in carious anterior upper primary teeth, a low level of evidence was found for higher failure rates of glass ionomer cement and composite fillings than composite strip crowns even if placed under general anaesthesia and especially compared to other crowns (stainless steel and zirconia). In conclusions, ECC may be managed successfully with nonoperative (SDF, regular fluoride application) and moderately well with operative approaches, but the decision is affected by many other variables such as pulpal involvement, the child’s cooperation, or a general anaesthesia setting.