Malocclusion central cusp in children is less common. Malocclusion central cusp in children, also known as malocclusion central cusp, is rare in milk teeth usually seen in permanent teeth. Usually located in the first premolar, the second premolar occlusal surface appears a conical cusp, protruding from the surface of the teeth. The central cusp protrudes from the surface of the tooth and will touch the tooth in advance when biting, resulting in occlusal discomfort. If left untreated, the central cusp may break off, exposing the pulp directly, which will soon lead to pulpal infection, or even lead to apical periodontitis. A low, rounded central cusp requires no treatment asymptomatically. A high, sharp central cusp should be regraded and ground in stages before a jaw-to-jaw relationship is established. The infection should be treated promptly to remove the infected pulp in order to save the tooth and avoid pain. If periapical infection has already occurred, a root canal is required, after which the tooth is filled with a special material. If the root of the tooth is too short or the periapical lesion is extensive and the tooth has become significantly loose, it needs to be extracted. Children with malformed central cusps that do not affect the bite can be observed and left to fall out naturally, if it affects the function it is recommended to seek medical treatment.