Objectives: A cross-sectional study was carried out to investigate the presence of dental caries in permanent first molars in 1,205 schoolchildren, aged from 7 to 12 years, enrolled in both private and state schools in the city of Recife, state of Pernambuco, Brazil, in the months of October and November 2000. Methods: The clinical examinations were performed in accordance with the criteria of the World Health Organization (WHO, 1999) by a duly calibrated examiner. The socioeconomic and demographic data was collected by means of a questionnaire. The statistical analysis comprised frequency distribution, determination of means, standard deviation and bivariate and multivariate variation, using a 5% level of significance. Results: The results revealed that 38.3% of the state school children showed caries in permanent first molars, compared with 15.9% in the children attending private schools. The age of greatest prevalence was 10 years, peaking at 41% for state schools and 14.1% for private schools, the difference between the state and private schools being statistically significant (P<0.001). In the state schools 5.5% of the children had lost at least one permanent first molar compared with 1.6% in the private schools. When Fisher’s exact test was performed, a highly significant difference was noted between the schools (P<0.001 and odds ratio 3.46). The lower first molars had more caries, restorations and tooth loss, the occlusal surface being the worst affected by caries and restorations. Conclusion: An important finding reveals that, despite the fact that public sector children exhibit a greater number of carious lesions, it is the private sector children who received most restorative treatment, which demonstrates a deficiency in the poorer children’s access to dental services.