Enamel wear: Diagnosis

DHCP with patient

How to diagnose enamel wear

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

Clinical appearance is critical to identifying enamel erosion. Over time, the wear caused by enamel erosion can lead to reduced thickness of tooth enamel and a change in the texture, shape, and appearance of the teeth, which may also cause teeth to become sensitive.2,3

These include 2,3:

  • Yellowing (advanced sign)As erosion becomes more severe, enamel thins, exposing the dentin underneath and causing teeth to appear yellow or discolored.
  • Thinning and translucencyTeeth that appear thin and translucent are a sign that tooth enamel erosion may have already begun.
  • Surface changes (smoothing)One sign of dental erosion is the loss of the surface of the tooth, leading to a smooth, shiny appearance.
  • Loss of structural features (rounding)Dental erosion, if untreated, can lead to the progressive loss of the surface of the tooth. The loss of tooth structure can require complex and lengthy treatment involving fillings, veneers, crowns, and potentially root canals.
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 wear4 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.

The BEWE in practice

  • 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)?
  • Dentition divided into sextants

    BEWE scores describe how severely 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 tissue 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

  • 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 - helping your patients manage dentine hypersensitivity due to enamel wear

Dentist icon

Management

Explore an overview of enamel wear management.

Find out more

Toothbrushing icon

Enamel wear

Find out more about enamel wear.

Find out more

Orange segment

Causes and mechanisms

Find out about the causes and mechanisms behind enamel wear.

Find out more

Family icon

Impact on patient quality of life

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

Find out more

Pronamel logo

The Sensodyne range

Find out how the Sensodyne range can help your patients with dentine hypersensitivity due to enamel wear.

Find out more

Patient resources icon

Patient care resources

Download resources for your patients.

Find out more