Erosive tooth wear is the third most commonly observed dental condition, after caries and periodontal disease. Though the development rate for erosive tooth wear is slow, it can greatly impact the quality of life in later years. In this blog, we will talk about erosive tooth wear and how dental professionals can identify erosive tooth wear.
Erosive tooth wear is a condition that affects a large number of patients throughout the world. Some of the most common features of erosive tooth wear include:
- Yellowing of teeth
- Thinning and translucency
- Surface changes
- Loss of structural features
To control these issues and reduce the risk of missing a diagnosis, it is vital that all dental professionals must screen all their patients. So, what’s the best way to screen erosive tooth wear? Well, the Basic Erosive Wear Examination or BEWE is a simple screening tool that can be used as a part of every clinical exam along with the basic periodontal examination (BPE). Being a part of every clinical exam, BEWE allows clinicians to make a record and inform the patient of their risk of erosive tooth wear.
The importance of BEWE as a screening tool
Created in 2008 for general dentists, the BEWE is a simple screening tool that alerts clinicians to the presence of severe tooth wear. BEWE works similar to the Basic Periodontal Examination (BPE) and uses the same protocol. It is based on a four-point grading system (0-3) to allow efficient analysis of patients with tooth wear.
- 0 – no wear
- 1 – early signs of wear
- 2 – involving changes less than 50% of the surface
- 3 – involving changes greater than 50% of the surface
The clinicians record the tooth surface with the most severe score in each sextant. And the total mouth score is added to give a risk assessment. For patients above the age of 20 years, their dentition is rarely wear-free. A BEWE score of one is normal. However, if there is any doubt, the lower score should be chosen. The difference between grade zero and one is minor. However, the most important distinction is between grades two and three.
How BEWE is performed?
Various steps are involved in the process of BEWE. Some of the key steps include:
- Before conducting a clinical examination, the teeth should be cleaned properly.
- After cleaning the teeth, the buccal, lingual/palatal, occlusal and/or incisal surfaces should be assessed in each sextant under good lighting.
- Permanent molars are usually excluded. However, they should be considered if they replace a second permanent molar.
- Restorations that cover more than 50% of the total surface should be discarded. The other surfaces in the sextant can be used to specify the score.
- If no signs of erosive tooth wear are detected, a BEWE score of zero is allocated.
- In case, an initial loss of surface texture (such as opaque surface, ‘frosted glass’ appearance, or brightness loss) is detected, a BEWE score of one is allocated.
- If a distinct wear defect with hard tissue loss is found, which is affecting less than 50% of the surface area, a BEWE score of two is allocated.
- If the distinct wear defect with hard tissue loss affects more than 50% of the surface, it is allocated a grade three.
BEWE (0-3) scores- detailed explanation
Let’s look at various BEWE scores in detail for:
- The occlusal surfaces of molars and premolars
- The palatal/lingual and buccal surfaces of anterior teeth
BEWE scores related to the occlusal surfaces of molars and premolars
BEWE score 0
- No signs of wear on the occlusal surface
- Occlusal surfaces with no signs of tooth wear around a restoration interface
- If the enamel development defects, fluorosis, opacities, and amelogenesis do not involve changes to the shape of teeth due to wear, these are scored 0
BEWE Score 1
- First signs of tooth wear are detected which involve rounding of the cusps and grooves
- Concavities on cusps (cupping) are found with a diameter of ≤0.5 mm.
BEWE Score 2
- Distinct defect with tooth wear is detected on less than 50% of the whole surface area.
- Concave wear on cusps (cupping) is found with a diameter ≥0.5 mm and overall <50%
BEWE Score 2
- Hard tissue loss signs are found for more than 50% of the surface area
- The overall or near-total loss of the occlusal surface covers more than 50%
BEWE scores related to the palatal/lingual and buccal surfaces of anterior teeth
BEWE Score 0
- No tooth wear signs are found on the buccal/palatal/lingual surface
- If enamel developmental defects, fluorosis, opacities, amelogenesis, and others do not involve changes to the shape of teeth due to wear, 0 score is allocated
- Although anatomical defects are visible but they show no signs of wear, they can be scored as 0
BEWE Score 1
- Initial loss of surface texture like brightness loss, opaque surface, or ‘frosted glass’ appearance is detected
- Minimal loss of the incisal edge is found
BEWE Score 2
- Hard tissue loss is found on less than 50% of the surface area
- Loss of clinical crown height less than 50% from the buccal aspect can be given a score of 2
BEWE Score 3
- Hard tissue loss signs are detected covering more than 50% of the surface area.
- One important thing to note related to restored teeth is that the tooth wear can be scored for restored teeth only if the size of the restoration does not exceed 50%.
On the whole, the BEWE is a simple yet validated tool that plays an important role in primary dental care. Using this tool for the screening for wear in everyday practice can greatly help combat erosive tooth wear amongst patients. For the screening of erosive teeth or to know more about this condition, you can always call and fix an appointment with professionals at TruCare Dentistry, based in Roswell. G.A.