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Managing Dental Erosion: Current Understanding and Future Directions
The Basic Erosive Wear Examination (BEWE)

Course Author(s): Donald J. White, PhD; Warden H. Noble, DDS, MS, MSEd; Nicola West, BDS, FDSRCS, PhD FDS (Rest Dent)

The Basic Erosive Wear Examination (BEWE)

The BEWE, introduced by Bartlett, Ganss and Lussi in 2008,68 is used to assess the level of erosion. For this examination, the mouth is divided into six distinct areas for evaluation. Table 6 shows the criteria for sextant scores from 0 to 3, which are summed to obtain a cumulative score that is the basis for determining interventions (Table 7). The BEWE is a simple, quick index for screening a patient’s erosion status.

Table 6. BEWE Scores and Criteria.
Score Criteria Image
0 No ETW Photo of teeth with no ETW
1 Initial loss of surface texture Photo of teeth with initial loss of surface texture
2a Distinct defect; hard tissue loss involving <50% of the surface area Photo of teeth with hard tissue loss involving 50% of surface area
3a Hard tissue loss involving ≥50% of the surface area Photo of teeth with hard tissue loss involving greater than 50% of surface area
a Dentin often involved.
Table 7. Cumulative BEWE Scores and Management Guidelines.
Cumulative Score General guidelines for management
No ETW: 0 - 2
  • Routine maintenance and observation
  • Repeat at 3-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 6-12 month intervals
High: ≥14
  • Oral hygiene, dietary assessment
  • Routine maintenance
  • Fluoride measures
  • Repeat at 6-12 month intervals
  • Consider restorations
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