Diagnostic Indices for Epidemiological Assessment of Molar Incisor Hypomineralization: A Systematic Review

Molar incisor hypomineralization (MIH) is a qualitative developmental defect of enamel and one of the most prevalent oral health conditions in childhood. Over the last two decades, increasing attention has been given to its prevalence and etiology; however, marked heterogeneity in diagnostic criteria and indices has limited the comparability of epidemiological findings. This systematic review aimed to identify and describe the diagnostic indices used for the epidemiological assessment of MIH in the general pediatric population. A systematic literature search was conducted in PubMed, Scopus, and Google Scholar to identify epidemiological studies published between January 2001 and December 2024 reporting MIH prevalence in children. Study selection, data extraction, and methodological quality assessment were performed independently by two reviewers in accordance with PRISMA guidelines. The review protocol was registered in PROSPERO (CRD42022345224). A total of 198 articles were included, corresponding to 201 independent epidemiological studies, as three articles reported results from two distinct study populations. The European Academy of Paediatric Dentistry (EAPD) criteria were used in 171 studies (75.7%), representing the most widely adopted diagnostic index. Other indices, including the modified Developmental Defects of Enamel index (mDDE), Mathu-Muju and Wright, Wetzel and Reckel, MIH Severity Scoring System (MIH-SSS), the MIH Treatment Need Index (MIH TNI) criteria, and FDI criteria, were used infrequently. Studies using EAPD criteria accounted for the largest cumulative sample size and showed a descriptively aggregated MIH prevalence of 12.9%, whereas prevalence estimates varied across alternative diagnostic indices. In conclusion, the lack of uniform diagnostic standards and nomenclature hampers global surveillance and limits the comparability of prevalence data. The adoption of MIH-specific diagnostic criteria, supported by adequate examiner calibration and transparent reporting, is essential to improve the quality, consistency, and interpretability of future epidemiological research.