Diagnosing Erosive Tooth Wear

Dentist checking patient for signs of enamel erosion

How to diagnose erosive tooth wear

Erosive tooth wear is gradual and can be hard to detect during the early stages.1 Explore the tools that can help you identify erosive tooth wear.

Early diagnosis of erosive tooth wear is important to prevent further, lasting damage2

Diagram of teeth with enamel erosion. Signs include yellowing teeth, smooth enamel, rounded edges, enamel thinning

Common features of erosive tooth wear3,4

These include:

  • Yellowing (advanced sign)
  • Thinning and translucency
  • Surface changes (smoothing)
  • Loss of structural features (rounding)
Other signs of enamel wear

Other signs of erosive tooth wear4

These include:

  • Palatal erosive tooth wear
  • Occlusal cupping5

The Basic Erosive Wear Examination (BEWE)

The BEWE is a quick, effective, validated tool for assessing erosive tooth wear.6 It is recommended in the latest UK Department of Health oral healthcare guidelines,7 and was a key tool in the ESCARCEL study; the first pan-European epidemiology study on non-carious cervical lesions (NCCL) and associated risk factors, and the largest and most comprehensive study of its kind.8

Find out more about this GSK-supported study here.

Professor David Bartlett discusses the BEWE tool

Learn how to use the BEWE tool in practice from Professor David Bartlett at King’s College London Dental Institute.

The BEWE in practice

  • Step 1 – Talk to your patient

    Dentist icon

    How to diagnose erosive tooth wear

    Your patient’s diet or dietary habits may increase their risk of erosive tooth wear.7 Ask them the following questions to help determine their risk:6

    • How many times do you consume acidic foods or drinks in a day?
    • Do you have a history of gastric reflux?
    • Do you swish or hold acidic drinks in your mouth?
    • Do you frequently take liquid medication (which may be acidic)?
  • Step 2 – Assign BEWE scores

    Diagram of upper, lower, right and left teeth in the mouth

    BEWE scores describe how severely each sextant of your patient’s dentition is affected by erosive tooth wear. Each sextant should be assigned a score of 0 to 3:6

    0. No erosive tooth wear

    1. Initial loss of enamel surface texture

    2. Distinct defect, hard issue loss extending over less than 50%* of the surface area

    3. Hard tissue loss extending over 50%* or more of the surface area

    Once assigned, the scores from each sextant can be used to calculate a cumulative BEWE score.

    *In scores 2 and 3, dentine is often involved

  • Step 3 – Make your recommendations

    Based on your patient’s cumulative BEWE score, plan an appropriate management strategy. The table below gives recommendations for each cumulative score bracket.6

    Score (cumulative score of all sextants) Management
    None: 0–2*
    • Repeat BEWE as part of each routine clinical examination
    Low: 3–8*
    • Oral hygiene, dietary assessment & advice
    • Routine maintenance and recommend low abrasion toothpaste
    • Repeat BEWE as part of each routine clinical examinations
    Medium: 9–13
    • Identify main aetiological factors involved in the ET
    • Consider additional fluoridation measures/strategies to increase resistance to the hard tissue surface
    • Avoid placement of restorations
    • Monitor with study casts, clinical photographs, silicone impressions etc
    • Repeat BEWE at least every 6-12 months
    High: 14 or over*
    • Consider restorative intervention
    • Consider specialist referral

    Table adapted from Bartlett et al. 20086

    *Cut-off values are based on experience

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