Diagnosing Tooth Erosion

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How to diagnose tooth erosion

Enamel wear is gradual and can be hard to detect during the early stages. Explore the tools that can help you identify enamel wear.

Early diagnosis of enamel wear is important to prevent further, lasting damage1

Common enamel wear features

Common features of enamel wear2,3

These include:

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

Other signs of enamel wear2,3

These include:

  • Palatal erosive tooth wear
  • Occlusal cupping

The Basic Erosive Wear Examination (BEWE)

The BEWE is a quick, effective, validated tool for assessing enamel wear.4 It is recommended in the latest UK Department of Health oral healthcare guidelines,4,5 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.

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

    Female Dentist icon

    How to diagnose tooth erosion

    Your patient’s diet or dietary habits may increase their risk of erosive tooth wear.3,6 Ask them the following questions to help determine their risk:

    • 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

    Dentition divided into sextants

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

    0. No erosive 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.4

    Score (cumulative score of all sextants) Management
    None: 0–2*
    • Routine maintenance and observation
    • Repeat at 2-year intervals
    Low: 3–8*
    • Oral hygiene, dietary assessment
    • Routine maintenance and observation
    • Repeat at 2-year intervals
    Medium: 9–13
    • Oral hygiene, dietary assessment
    • Routine maintenance
    • Fluoride measures
    • Avoid restorations
    • Repeat at 3–6 months intervals
    High: 14 or over*
    • As above, with the exception of the following:
    • Consider restorations

    Table adapted from Bartlett et al. 20084

    *Cut-off values are based on experience

Sensodyne Pronamel – helping protect your patients against enamel wear

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Management

Explore an overview of enamel wear management.

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Enamel wear

Find out more about enamel wear.

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Causes and mechanisms

Find out about the causes and mechanisms behind enamel wear.

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Impact on patient quality of life

Find out about the impact enamel wear has on patients’ daily lives.

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The Sensodyne range

Find out how the Sensodyne range can help your patients.

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Patient care resources

Download resources for your patients.

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