BEWE Assessment Quiz for Dental Students

Tooth Wear 2

• Lectures: Tooth Wear 1: Pre-recorded and workbook; Tooth Wear 2: Pre-recorded and quiz; Tooth Wear 3: Live lecture with case studies for applying theory.
• Assessments: Formative assessments include a workbook, quizzes and case studies. Summative assessments are in the form of e-assessments or case studies.
• Intended Learning Outcomes: Students should be able to describe and detect clinical signs and symptoms of tooth wear, describe the BEWE screening tool and outline preventative management strategies. The GDC learning outcomes 1.1.2, 1.1.4, 1.1.8, 1.7.7, 1.10.1, 1.10.2, 1.10.3, 1.10.4, and 1.10.6 are covered.
• Clinical Detection (Signs and Symptoms): Clinical signs, BEWE screening tool and patient history are used for detection.

Detection

• Clinical examination: Includes examination of clinical signs.
• Patient factors: Patient complaints (how they noticed any changes), symptoms and medical history are considered.
• Tooth wear risk assessment: Combines clinical examination findings and patient factors to assess risk.

Clinical Detection

• Preparation: Mirror, dry surface, 3-in-1 or cotton rolls are used.
• Systematic approach: Used throughout the clinical examination process.
• Clinical signs examination: Examination of occlusal, incisal, palatal/lingual, and buccal/cervical areas.
• BEWE (Basic Erosive Wear Examination): A systematic screening tool, similar to BPE, specifically used for hard tissues and its basic examination process is described.

Tips to Detect Clinical Signs

• Normal tooth morphology knowledge: Students are advised to use their knowledge of normal tooth morphology.
• Subtle changes: Early stages of tooth wear might not be obvious. Look for subtle changes to tooth morphology.
• Physiological processes: Most adults show some signs of tooth wear due to normal physiological processes.
• Patient age: Assess the rate of wear compared to the patient's age.

BEWE Index

• BEWE score (per sextant): A scoring system from 0 to 3 representing different levels of erosive wear.
• Description of each score: Detailed descriptions are provided for each score (0, 1, 2, and 3), outlining the type and degree of tooth wear observed.
• Cumulative score calculation: Each score per sextant is added to obtain a cumulative BEWE score (maximum 18) for the patient.

Images of Various BEWE Scores

• Different images show varying levels of tooth wear (0 to 3). These images are meant for illustrating the stages of erosive tooth wear and corresponding BEWE scores.
• Each image is labelled with its corresponding BEWE score value

Cuspal Changes

• Healthy cusp morphology: Healthy teeth have pointy cusps with steep inclines, resembling a mountain top.
• Flattened morphology: Shows a flattened or rounded cusp, a sign of tooth wear.

BEWE 3

• Palatal surface extent: More than 50% of the palatal surface is affected and exposed dentin is noticeable, particularly at the gingival margins and incisal edges.

• Halo effect: A "halo effect" (visible exposed dentin) is apparent.

• Possible sensitivity: Dentin hypersensitivity may be present, depending on the activity of the tooth wear process.

• Diagnosis/Clinical Information (with images): Various images (f, c) are labeled accordingly to illustrate different stages and scores in the BEWE process. Specific information accompanies the images to explain the type and degree of tooth wear.

Patient Factors in Risk Assessment

• Age: The rate of tooth wear relative to the patient's age.
• Patient history: Includes verbal history of aetiological factors, exposures to internal and external acids (e.g., acidic foods/drinks, acid reflux) occupation, medical history (e.g., including seamstress pins), past and current fluoride exposure, habits (stress, habits), and dietary factors, including symptoms (e.g. due to exposed dentin and loss of smear layer) and noticing changes such as anterior teeth chipping or reports of grinding. Saliva is a key modifying factor.

Interventions

• Preventive interventions: Include providing tailored advice on oral health, non-abrasive brushing, low abrasive toothpaste, avoiding brushing after acidic foods/drinks/vomiting/reflux, using fluoride toothpaste and spitting, and appropriate diet advice (identifying potential contributing factors to tooth wear, eliminating or reducing acidic foods/drinks, limiting acidic drinks to meal times, encouraging buffering with water).
• Fluoride supplements/advice: Maximizing fluoride exposure through prescription fluoride toothpaste (2800/5000ppm) and/or mouthwash (0.05% fluoride).
• Monitoring: Taking impressions for study models and clinical photographs at intervals helps monitor change over time.
• Occlusal splint: Considered only when erosion is under control.

Restorative Options

• Restorative interventions: Restorations may be necessary, depending on the severity and stability of tooth wear.
• Bonding, veneers, or crowns: Possible restorative options include bonding, veneers, crowns, or complex build ups.
• Referral: Referral to a specialist could be needed depending on complexity.

Referrals

• Scope limitations: Severe tooth wear, bruxism, complex restorative care, query eating disorder, or GORD (Gastro-esophageal reflux disease) could potentially be outside the scope of the provided care. Referrals to a GDP or specialist would be required in these complex cases.

Summary

• Detection elements: Risk assessment; patient history; clinical signs (including use of the BEWE).
• Interventions: Preventive, Monitoring, and Restorative interventions.

Test your knowledge on the BEWE (Basic Erosive Wear Examination) screening tool and its application in detecting tooth wear. This quiz covers scoring, assessment tips, and common outcomes related to tooth wear assessment. Perfect for dental students or professionals enhancing their understanding of dental erosion.