Recommendations and guidelines for dentists using the basic erosive wear examination index (BEWE)

Abstract

This paper explains how to screen tooth wear in general practice using the Basic Erosive Wear Examination (BEWE) index. It explains how stakeholders in the UK acknowledged the convenience of the BEWE and that it could be recorded at the same time as the Basic Periodontal Examination (BPE). The article contains examples of anterior and posterior tooth wear for each BEWE score to help dentists in their evaluation.

Fig. 1

a) Occlusal surface of a premolar and molar showing no signs of erosive tooth wear. b) No sign of erosive tooth wear on buccal or occlusal surface. c) A molar with hypoplasia but no sign of erosive tooth wear. d) BEWE score 1 showing early signs of erosive tooth wear with discrete, small erosive lesions on occlusal surface. e) BEWE 2 on the premolar. The wear is just less than 50%. f) BEWE 3 showing erosive tooth wear covering more than 50% of the tooth surface. g) although erosive tooth wear visible the restoration covers more than 50% of the surface and therefore cannot be scored

Fig. 2

a) BEWE score 0 on anterior teeth showing unworn teeth. b) BEWE 1 showing a discrete area of wear on the UR1 on the buccal (facial surface) but no other signs of wear. c) BEWE 2 -shows less than 50% loss with signs of erosive tooth wear on the buccal (facial) surface but also some loss of the incisal edge. d) BEWE 3 greater than 50% of the surface affected. e) In this case the erosion has removed all of the palatal enamel giving a score 3

Fig. 3

a) However slight wear is visible on the incisal surface of the canines so a sextant score of 1 is representative of wear in this sextant. b) the whole of the incisal edge of the two central incisors has wear and given a score 3 whereas on the canines the wear is less and would be a 2. The sextant score is 3. c) The wear has clearly involved the whole incisal edge and is given a 3. d) The wear is clearly seen on the incisal edge but there has also been some shortening of the teeth

Fig. 4

If a blunt end probe is run along the margin it is easier to determine as a normal feature

Fig. 5

Even though tooth wear has produced the lesions associated with the crowns they cover more than 50% of the surface and therefore the sextant cannot be scored

Fig. 6

a) The lesion is carious and not erosive. b) Again a primarily carious lesion even though it appears to have some evidence of wear