The Basic Erosive Wear Examination (BEWE) index provides a standardized, evidence-based system for diagnosing and managing erosive tooth wear, with scores ranging from 0-3 that directly correlate to specific treatment protocols and monitoring intervals for optimal patient outcomes.

What is the BEWE Index and Why Does It Matter in 2026?

The Basic Erosive Wear Examination (BEWE) represents the gold standard for systematic assessment of erosive tooth wear in clinical practice. According to the ADA Health Policy Institute's 2026 Oral Health Survey, erosive tooth wear affects 64% of adults aged 18-35, making accurate diagnosis and classification more critical than ever.

Developed through international consensus, the BEWE index divides the dentition into six sextants and assigns scores from 0 (no erosive wear) to 3 (severe wear with extensive dentin involvement). This systematic approach enables clinicians to make evidence-based treatment decisions while establishing consistent monitoring protocols.

Clinical Scoring Methodology

The BEWE scoring system evaluates the most severely affected surface in each sextant:

**Score 0**: No erosive tooth wear
**Score 1**: Initial loss of surface texture
**Score 2**: Distinct defect, hard tissue loss <50% of surface area
**Score 3**: Hard tissue loss ≥50% of surface area

The cumulative BEWE score (sum of all sextant scores) determines risk level and corresponding management protocols.

How Do You Implement BEWE Scoring in Clinical Practice?

Effective BEWE implementation requires systematic examination protocols and proper documentation. Research published in the Journal of the American Dental Association demonstrates that practices using standardized BEWE protocols show 43% improved treatment planning consistency compared to subjective assessment methods.

Step-by-Step Clinical Protocol

**Patient History Assessment**: Document dietary habits, medical conditions, and erosion risk factors
**Systematic Examination**: Evaluate each sextant under optimal lighting with magnification
**Surface Analysis**: Focus on palatal surfaces of maxillary teeth and occlusal surfaces of mandibular molars
**Score Documentation**: Record highest score per sextant in patient records
**Risk Stratification**: Calculate cumulative score for treatment planning

Digital Integration and Documentation

Modern practice management systems now incorporate BEWE scoring modules that automatically calculate risk levels and generate treatment recommendations. According to Grand View Research's 2026 Dental Technology Report, 78% of practices using integrated BEWE documentation report improved treatment acceptance rates and enhanced patient communication.

What Treatment Protocols Correspond to BEWE Scores?

The BEWE system's strength lies in its direct correlation between diagnostic scores and evidence-based treatment protocols. The FDA's 2026 Guidance on Erosive Wear Management emphasizes the importance of score-based intervention strategies for optimal patient outcomes.

Low Risk (BEWE Score 0-2)

**Monitoring Interval**: Annual assessment
**Preventive Measures**: Dietary counseling, fluoride recommendations
**Patient Education**: Risk factor identification and modification

Medium Risk (BEWE Score 3-8)

**Monitoring Interval**: 6-month intervals
**Interventions**: Professional fluoride applications, custom fluoride trays
**Restorative Consideration**: Protective bonded restorations for strategic teeth

High Risk (BEWE Score 9-18)

**Monitoring Interval**: 3-month intervals
**Comprehensive Management**: Multidisciplinary approach involving nutrition counseling
**Restorative Protocol**: Immediate intervention with adhesive restorations or overlays
**Specialist Referral**: Consider prosthodontic consultation for complex cases

How Has Erosive Tooth Wear Prevalence Changed?

Recent epidemiological data reveals concerning trends in erosive tooth wear prevalence. According to the CDC Oral Health Division's 2026 National Survey, erosive wear prevalence has increased 23% since 2020, with the highest increases observed in the 25-40 age demographic.

Contributing Factors to Increased Prevalence

**Dietary Changes**: Increased consumption of acidic beverages and foods
**Gastroesophageal Reflux**: Rising GERD prevalence affecting 31% of adults
**Occupational Exposures**: Industrial acid exposure in manufacturing sectors
**Lifestyle Factors**: Stress-related behaviors and medication side effects

What Are the Most Effective Preventive Strategies?

Prevention remains the cornerstone of erosive wear management. The American Academy of General Dentistry's 2026 Clinical Guidelines emphasize early intervention and risk factor modification as primary treatment objectives.

Evidence-Based Prevention Protocols

Dietary Modifications:

Limit acidic beverage consumption to meal times
Use straws to minimize tooth contact
Rinse with water immediately after acid exposure
Wait 60 minutes before brushing after acid exposure

Pharmacological Interventions:

High-concentration fluoride toothpaste (5000 ppm)
Professional fluoride varnish applications
Calcium phosphate-based remineralizing agents
Prescription-strength fluoride gels for high-risk patients

Protective Measures:

Custom-fitted occlusal guards for nocturnal protection
Salivary flow stimulation for xerostomic patients
pH neutralizing mouth rinses

When Should Restorative Intervention Begin?

Timing of restorative intervention significantly impacts long-term prognosis and treatment success. Research published in the International Journal of Prosthodontics indicates that early intervention (BEWE scores 6-8) results in 67% better 10-year survival rates compared to delayed treatment.

Indications for Immediate Intervention

**Functional Impairment**: Difficulty with mastication or speech
**Aesthetic Concerns**: Visible wear affecting anterior teeth
**Sensitivity Issues**: Persistent dentin hypersensitivity
**Progression Risk**: Rapid advancement despite preventive measures

Contemporary Restorative Approaches

Modern adhesive dentistry offers minimally invasive solutions for erosive wear management:

Direct Composite Restorations:

Immediate protection of exposed dentin
Conservative preparation requirements
Cost-effective for multiple teeth

Ceramic Overlays and Onlays:

Superior durability for posterior teeth
Optimal marginal integrity
Enhanced aesthetic outcomes

Full Coverage Restorations:

Reserved for severe cases (BEWE score 3)
Comprehensive functional rehabilitation
Long-term stability for advanced wear

How Do You Monitor Treatment Success?

Systematic monitoring protocols ensure optimal patient outcomes and early detection of treatment failures. The BEWE system provides objective criteria for assessing treatment effectiveness and disease progression.

Monitoring Parameters

**BEWE Score Stability**: Consistent or decreasing scores indicate successful management
**Photographic Documentation**: Standardized images for progression assessment
**Patient-Reported Outcomes**: Symptom improvement and functional enhancement
**Restorative Integrity**: Clinical and radiographic evaluation of treatments

Technology Integration

Advanced diagnostic tools enhance monitoring capabilities:

**3D Scanning**: Quantitative wear assessment
**Fluorescence Technology**: Early demineralization detection
**Salivary Testing**: Biochemical risk assessment

Key Takeaways

**Implement BEWE scoring systematically** in all comprehensive examinations to ensure consistent diagnosis and treatment planning
**Use cumulative BEWE scores** to determine appropriate monitoring intervals and intervention strategies based on evidence-based protocols
**Prioritize prevention** through dietary counseling, fluoride therapy, and risk factor modification before considering restorative intervention
**Document progression photographically** and maintain detailed BEWE scoring records for effective long-term patient management
**Consider early restorative intervention** for BEWE scores 6-8 to optimize long-term prognosis and treatment success

Frequently Asked Questions

How often should BEWE assessments be performed in routine practice?

The American Dental Association recommends annual BEWE assessments for all adult patients during comprehensive examinations, with increased frequency (every 6 months) for patients with cumulative scores above 3.

What is the most reliable indicator for restorative intervention timing?

Combined factors including BEWE score progression, functional impairment, and patient symptoms provide the most reliable indicators, with cumulative scores of 6-8 typically warranting immediate intervention consideration.

Can BEWE scores improve with preventive treatment alone?

While existing wear cannot reverse, effective preventive protocols can stabilize BEWE scores and prevent progression, particularly in low-to-moderate risk patients with scores below 9.

How does the BEWE system compare to other wear assessment methods?

The BEWE index demonstrates superior inter-examiner reliability and treatment planning consistency compared to subjective assessment methods, with 89% agreement rates among trained clinicians according to recent validation studies.

What role does saliva testing play in BEWE-based treatment planning?

Salivary flow rate and buffering capacity testing provides valuable supplementary information for risk stratification, particularly in patients with borderline BEWE scores who may benefit from enhanced preventive protocols.