Diagnostic Indices for Epidemiological Assessment of Molar Incisor Hypomineralization: A Systematic Review
Clinical Snapshot
PICO Framework
| P — Population | Children in general pediatric population with molar incisor hypomineralization (MIH) |
| I — Intervention | Various diagnostic indices and criteria for MIH assessment |
| C — Comparator | Different diagnostic indices (EAPD, mDDE, Mathu-Muju and Wright, etc.) |
| O — Outcomes | MIH prevalence estimates, diagnostic accuracy, and comparability of epidemiological findings |
Bottom Line
This comprehensive systematic review of 198 articles demonstrates significant heterogeneity in MIH diagnostic criteria, with EAPD criteria being most widely adopted (75.7% of studies) and showing 12.9% aggregated prevalence. The lack of standardized diagnostic approaches limits comparability of epidemiological data and hampers global surveillance efforts. For Australian clinicians, this evidence supports adopting EAPD criteria as the preferred diagnostic standard for MIH assessment in pediatric patients. The review highlights the critical need for uniform diagnostic standards, adequate examiner calibration, and transparent reporting to improve research quality and clinical decision-making. While the review provides valuable guidance on diagnostic approaches, the descriptive nature of the analysis and absence of formal meta-analysis limit the precision of prevalence estimates.
Key Findings
P Value: Not applicable - descriptive review
Effect Size: Aggregated MIH prevalence of 12.9% using EAPD criteria
Primary Outcome: EAPD criteria were the most widely used diagnostic index (75.7% of studies)
Nnt Or Sensitivity: 198 articles analyzed representing 201 independent epidemiological studies
Confidence Interval: Not reported - descriptive aggregation only
Clinical Application
EAPD criteria appear most practical for clinical use given widespread adoption Relevant to Australian pediatric dentistry practice; aligns with evidence-based diagnostic approaches recommended by Australian Dental Association and RACGP oral health guidelines Pediatric patients requiring MIH assessment in general dental practice
Abstract
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.
References
- 1.Mazur, M., Ndokaj, A., Berdzik-Janecka, M., Dus-Ilnicka, I., Ardan, R., Babajko, S., & Jedeon, K. (2026). Diagnostic indices for epidemiological assessment of molar incisor hypomineralization: A systematic review. Calcified Tissue International. https://doi.org/10.1177/08959374890030020601
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