The purpose of this study: This study aimed to evaluate the health condition of the first permanent molar, and to investigate oral health knowledge, attitudes, self-care practices (KAP), and utilization of dental services in a group of Palestinian school children, 12-years-old. Subject and Method: This cross-sectional observational study was conducted on primary schools in Tulkarem in west bank, Palestine. These schools were selected according to their geographic area, and classified into two main groups according to the degree of Urbanization: Group I (Urban schools), and Group II (Rural schools). Subjects included in the study were further subdivided according to sex into male and female groups. All students who participated in this study were from 6th and 7th grades, 12 years old. A close ended questionnaire was designed to investigate oral health knowledge, attitudes, self-care practices (KAP), and utilization of dental services. Besides that, clinical examination of dental caries for first permanent molar were performed using the World Health Organization (WHO) criteria. Data were collected through a questionnaire-based survey and DMFT index for first permanent molar were calculated and analyzed using chi-square (x2) test. Results: The mean DMFT index score of first permanent molar in the study sample was (2.17). Also, the mean decayed teeth (DT) index was (1.95), missed teeth (MT index) was (0.08), and for filled teeth (FT index) was (0.13). The mean DMFT index of the first permanent molars in this study showed no significant difference between students of urban and rural areas, and was found to be slightly higher in students in rural area compared to that of students in urban area. Caries prevalence (DMFT) of the first permanent molars showed that the girls (2.47) were significantly higher than boys (1.9) in both urban and rural areas. This study reported that 44.7% of students brushed their teeth on daily basis. Girls showed higher compliance to tooth brushing than boys in urban and rural areas. Regular flossing was not as common as brushing, only 5.8% reported using the floss daily, and 79.4% never used it. Conclusions: Caries prevalence among 12-year-old students in Tulkarem, Palestine is less than the global standards of WHO and FDI for 2000, but close to the gold standard for 2010. Therefore, the health of the first permanent molars can be considered as a good basis to study the oral health.