The primary and permanent teeth in humans may show anomalies related to numbers and morphology of crown and roots. There can be a variation in morphology, location, and prevalence of accessory cusps that can often lead to dental problems. The present case report is of a 9-year-old child exhibiting multiple accessory cusps on the occlusal surface of maxillary primary second molars and maxillary permanent first molars. This article highlights the clinical implications of condition and the associated problems.