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Introduction: The prevalence of molar incisor hypomineralization (MIH), the degree of severity of experienced molars, and their medium-term survival rate are factors that have reintroduced the decision to extract first permanent molars, via forced extractions or another chosen therapeutic option. Materials and method: The author summarizes pedodontic and orthodontic clinical studies in the management of patients with compromised first permanent molars in order to analyze the consequences of single or multiple extractions of these teeth. Results: Firstly, the consequences of extractions of the first permanent molars in the absence of malocclusion are studied. The goal is the establishment of all the teeth without orthodontic treatment. The impact of the age at which the extraction is practiced is a key factor. Next, extractions of first permanent molars in the presence of orthodontic anomalies are analyzed to define the optimal therapeutic strategies, the precautions during these treatments, and the contraindications. Consultation and good coordination between the generalist dentist/pediatric dentist and orthodontist are the key factors for stable and functional end-of-treatment results and optimized treatment duration. Discussion: Clinical experience and knowledge make it possible to properly select patients qualified for these therapies, which require multidisciplinary planning and good biomechanical control. Conclusion: By bringing together optimal decision-making conditions, extraction is a therapeutic option that often proves to be superior to a restorative option in providing our patients with the greatest long-term service.