Hypoplastic and hypomineralised first permanent molar teeth are a frequent finding in children. The treatment of these teeth can be challenging because of the young age of the patient at presentation and the varying anatomy of the affected surfaces. This article reviews the treatment of these teeth including the use of glass ionomer cements, direct and indirect restorations of composite resin, indirect precious and non-precious alloys, stainless steel crowns, and the timely extraction of severely affected teeth.