<p>Molar Incisor Hypomineralization (MIH) is a prevalent qualitative enamel defect recognized globally; however, data are lacking in Saudi Arabia, particularly in Abha city. This study aimed to determine the prevalence, clinical characteristics, and associated chief dental complaints of MIH among Saudi children in Abha. A cross-sectional, analytical hospital-based survey was conducted among 520 Saudi children aged 7–12&#xa0;years attending King Khalid University College of Dentistry. Clinical examinations were performed using standardized diagnostic criteria to assess MIH status, while demographic characteristics and chief dental complaints were recorded. MIH was diagnosed in 38.5% of participants (95% CI: 34.4–42.7). The upper right first permanent molar was most frequently affected (63%). Demarcated opacities were the predominant lesion type (71.5%), most involving less than one-third of the enamel surface (71.1%). MIH-positive children most frequently reported pain, sensitivity, and tooth decay (p &lt; 0.05). Significant tooth-specific differences were observed, with upper molars and incisors more commonly affected than lower counterparts (p &lt; 0.05; p &lt; 0.0001). Other enamel defects (non-MIH/HSPM) occurred more often in MIH-negative participants (p &lt; 0.001). MIH was highly prevalent among Saudi children in Abha, with gender differences and marked clinical dental complaints related to pain, sensitivity, and tooth decay. The study also demonstrated distinct tooth-specific patterns and a higher frequency of other enamel defects (non-MIH/HSPM) among MIH-negative children. These conclusions provide important baseline data for forthcoming surveillance and preventive measures. Furthermore, these results emphasize the necessity of early screening and comprehensive management within Saudi pediatric dental practice.</p>