Background <p>The COVID-19 pandemic has led to significant restrictions in access to oral health services and may have affected the need for dental treatment in pediatric patients. This study aimed to retrospectively evaluate the effect of the COVID-19 pandemic on the extraction rates of permanent first molar teeth in pediatric patients aged 9–14 years.</p> Methods <p>In this retrospective archival study, the records of patients aged 9–14 years who visited our clinic between January 1, 2017, and December 31, 2025, were reviewed. The study period was divided into three periods: pre-pandemic (January 1, 2017–March 9, 2020), pandemic (March 11, 2020–May 5, 2023), and post-pandemic (May 6, 2023–December 31, 2025). The number of permanent first molar extractions and their proportion of total extractions were compared across ages and periods. Pearson’s chi-square test was used to analyse the data, and a significance level of p &lt; 0.05 was accepted.</p> Results <p>Extraction rates were positively associated with increasing age across all study periods (p &lt; 0.001). It was determined that the rate of permanent first molar extractions increased significantly in the post-pandemic period compared to the pre-pandemic period (RR = 1.82; 95% CI: 1.69–1.95; p &lt; 0.001). Although there was a decrease in the total number of extractions during the pandemic period, the rate of permanent first molar extractions among total extractions were found to be significantly higher than before the pandemic (RR = 1.4; 95% CI: 1.28–1.53; p &lt; 0.001).</p> Conclusion <p>The COVID-19 pandemic was found to have a significant effect on permanent first molar extraction rates in pediatric patients. Restrictions in access to oral health services and delayed visits during the pandemic may be associated with increased extraction rates in the post-pandemic period. These findings emphasize the importance of continuity of preventive oral health services during extraordinary circumstances.</p>