Early Childhood Caries (ECC) is a multifactorial, biofilm-mediated, sugar-related, dynamic disease of dental hard tissues occurring in varying degrees of severity in infants and toddlers from the first deciduous tooth to approximately seven years of age. With a prevalence in young children of approximately 5-20% in Germany (Splieth et al., 2009) or 3-45% worldwide (Borutta et al., 2010), as documented in socio-epidemiological studies, and not only in vulnerable groups, it has gained importance among parents, physicians, dentists, midwives, health insurers and policy makers alike. Common consequences of untreated early childhood caries can be, in addition to pain and infections, impaired development of the jaws and permanent teeth, insufficient feeding behavior, dyfunctional chewing and swallowing or impaired speech development. In order to intervene in time, prevention is necessary in addition to education; restorative procedures often require additional sedation or anesthesia. Cost efficiency has taken on an important role in today's public health care system. The cost-effectiveness requirement of statutory or government health insurance may influence treatment decisions. The aim of this study was to systematically examine and evaluate global scientific evidence on cost-effectiveness in treatment decisions on early childhood caries. The systematic review should include observational epidemiological studies, *i.e.*, cohort studies, case-control studies, and randomized controlled trials reporting on the cost-effectiveness of treatment decisions of early childhood caries in infants and young children according to PRISMA guidelines. Using an *ad hoc* search string with search terms and keywords (MeSH), the electronic databases Scopus, MEDLINE via PubMed, and Embase will be searched. The results should provide information on the cost-effectiveness of treatment decisions for early childhood caries and provide important information for parents, physicians, dentists, health insurers and policy makers involved in the health care process to improve and finance future treatment decisions for early childhood caries in infants and young children.