Diagnosing Tooth Erosion

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 features of enamel wear^2,3

These include:

Yellowing (advanced sign)
Thinning and translucency
Surface changes (smoothing)
Loss of structural features (rounding)

Other signs of enamel wear^2,3

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
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

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