Basic Erosive Wear Examination (BEWE)
Basic Erosive Wear Examination
- Last updated November 23, 2025
✅ Objectives
By the end of these revision notes, you should be able to:
- Understand the basics of why the BEWE was introduced
- Describe the principles and scoring system of the BEWE indext
- Interpret the BEWE score and create an appropriate management strategy
What is the BEWE?
Tooth surface loss can be caused by erosion, attrition, abrasion or abfraction.
The Basic Erosive Wear Examination (BEWE) is a simple, reproducible and validated screening tool aimed at recording and monitoring erosive tooth surface loss. Bartlett et al. (2008) introduced the BEWE to help with recording this information in a similar fashion to the BPE.
The BEWE quantifies the severity of erosive tooth surface loss across the dentition. This will also provide a summary score that can be used to categorise patients in to various risk levels and, therefore, guidance on management.
How to carry out the BEWE
Like the BPE, the mouth is divided in to sextants.
All tooth surfaces are then examined in each sextant and the most severely affected surface is identified.
Only the worst lesion in each sextant is scored.
|
Score
|
Description
|
Example of clinical features
|
|---|---|---|
|
0
|
No erosive wear
|
Enamel intact and no loss of contour
|
|
1
|
Initial loss of surface texture
|
Enamel appears dull/matt but no dentine exposure
|
|
2
|
Distinct defect, hard tissue loss <50% of surface area
|
Dentine visible on <50% of the surface
|
|
3
|
Hard tissue loss ≥50% of surface area
|
Dentine visible ≥50% of surface, extensive wear, pulpal exposure may be present
|
Following scoring of each sextant, the scores are added together giving a total score for the BEWE.
Interpreting the BEWE score
|
Total Score
|
Risk Level
|
Clinical Management
|
|---|---|---|
|
0-2
|
No risk
|
Routine maintenance
Reinforce preventative advice |
|
3-8
|
Low risk
|
Routine monitoring
Dietary counselling Fluoride application |
|
9-13
|
Medium risk
|
Identify causes
Detailed and tailored preventative advice Topical fluoride preparations Monitor regularly |
|
≥14
|
High risk
|
Full preventative plan
Restorative intervention if stabilised or to prevent pulpal damage Monitor regularly |
Examples of Intervention Strategies
Some examples of interventions to manage medium/high risk:
- Fluoride preparations – fluoride varnish, high fluoride toothpaste (2800ppm and 5000ppm)
- Consider GP referral if acid reflux is suspected
- Tailored dietary advice – drinking through a straw, avoid fizzy drinks etc
Summary
- The BEWE is validated and simple way to assess erosive tooth surface loss in a patient.
- The mouth is divided in to sextants and each sextant is scored.
- The total score is then used to risk stratify patients and determine best management strategies.
Bartlett, D., Ganss, C. and Lussi, A. (2008). Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs. Clinical Oral Investigations, [online] 12(S1), pp.65–68. doi: https://doi.org/10.1007/s00784-007-0181-5. [LINK]
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