Monitoring Erosive Toothwear: BEWE 2019 PDF

OPINION Monitoring erosive toothwear: BEWE, a simple tool to protect patients and the profession David W. Bartlett,*1 Soha Dattani,2 Ian Mills,3 Nigel Pitts,4 Raj Rattan,5 Diane Rochford,6 Nairn H. F. Wilson,7 Shamir Mehta8 and Saoirse O’Toole9 Key points Highlights the imp...

OPINION Monitoring erosive toothwear: BEWE, a simple tool to protect patients and the profession David W. Bartlett,*1 Soha Dattani,2 Ian Mills,3 Nigel Pitts,4 Raj Rattan,5 Diane Rochford,6 Nairn H. F. Wilson,7 Shamir Mehta8 and Saoirse O’Toole9 Key points Highlights the importance of early identification of Discusses the role of preventative advice in patient Suggests the use of the basic erosive wear erosive tooth wear. management. examination (BEWE) in monitoring erosive tooth wear. Abstract Erosive tooth wear is the third most commonly observed oral condition after caries and periodontal disease, with a prevalence similar to that of dentine hypersensitivity. However, it is not a condition that is routinely screened, or monitored, as part of the standard dental examination. Following a meeting held in 2018, this paper considers the outlook for erosive tooth wear and the need for dental professionals to monitor for signs of the condition as part of an oral health assessment, to provide protection for patients and the profession. The use of the basic erosive wear examination (BEWE) is proposed as a simple screening tool designed to detect erosive tooth wear in clinical practice. Introduction tooth wear, and while the condition tends to wear and the greatest increase in moderate have a slow rate of progression, the potential tooth wear was seen among young adults.1 Erosive tooth wear is now the third most impacts are far reaching. Little is known about The increased mobility of younger generations commonly observed oral condition, after caries its progression. For some, this means a slow to move for work or study may also impact and periodontal disease, with a prevalence gradual progression but for others it undergoes care. The reduction in the consistent patient- similar to that of dentine hypersensitivity. rapid change and can compromise the practitioner relationship may make it more However, it is not a condition that is routinely longevity of the dentition. Added to which, it difficult to spot a slowly progressing condition, screened or monitored as part of the standard is a condition that often affects the ‘committed’ such as erosive tooth wear. dental examination. patient, as it is not triggered by a lack of oral Full mouth rehabilitation of erosive tooth Increasing expectations of patients and hygiene or high levels of plaque. As increasing wear is expensive and time consuming. the public mean that there is an increased numbers of patients retain natural teeth for According to a study by O’Toole et al., costs risk of dissatisfaction and litigation. There is longer, we are likely to see an increase in the could be up to £13,000 for private treatment still so much that is unknown about erosive prevalence of signs of tooth wear. on average and treatment could take up to 24 Unlike other common conditions, which may months.2 It is important that patients are made 1 Department of Prosthodontics, Faculty of Dentistry and be monitored as part of an oral health assessment, aware of the condition at the earliest stage, Oral & Craniofacial Sciences, King’s College London, the initial stages of tooth wear do not require ideally before it reaches the need for restorative London, UK; 2Director Scientific & Professional Affairs, GlaxoSmithKline Consumer Healthcare, London, UK; chairside intervention. The role of the dental intervention. In an increasingly litigious 3 Dean, Faculty of General Dental Practice (UK), London, professional is to highlight the condition and society, it is important that the patient realises UK; 4Director, Dental Innovation & Impact, and Faculty of Dentistry and Oral & Craniofacial Sciences, King’s College support the patient in the management of risk that progression of the condition is dependent London, London, UK; 5Dental Director, Dental Protection, factors, including diet and the management of on their behaviour and not an oversight of the London, UK; 6President Elect, British Society of Dental Hygienists & Therapists, Rugby, UK; 7Emeritus Professor of intrinsic factors such as acid reflux. heathcare provider. Dentistry, King’s College London, London, UK; 8Faculty of Examination for erosive toothwear should Dentistry and Oral & Craniofacial Sciences, Conservative & MI Dentistry, King’s College London, London, UK; Outlook for erosive tooth wear be part of a routine oral health assessment. A 9 Department of Prosthodontics, Faculty of Dentistry and regular and consistent approach means that Oral & Craniofacial Sciences, King’s College London, London, UK. With modern lifestyles and an ageing the dentist or other oral healthcare provider *Correspondence to: David Bartlett population it is inevitable that erosive tooth routinely examines the teeth for tooth wear, Email: [email protected] wear will continue to feature in future patient informs the patient and, if identified, can Refereed Paper. populations. According to the most recent commence prevention. Until this becomes Accepted 4 March 2019 Delivering better oral health guidance, over routine, and part of the clinical examination, DOI: 10.1038/s41415-019-0411-7 three quarters (77%) of adults have some tooth there is a risk that patients will continue to 930 BRITISH DENTAL JOURNAL | VOLUME 226 NO. 12 | June 28 2019 © The Author(s), under exclusive licence to British Dental Association 2019  OPINION Fig. 1 Introducing the BEWE as part of an oral health assessment History: the following routine questions should be asked as part of dietary/habits history 1. Frequency of acidic foods and drinks outside meal times Red flags/risk factors to watch out for: 2. Dietary habits: swishing or holding drinks in mouth Frequent acidic foods 3. Reflux related causes. – Snacks on acidic food/drinks at least twice per day between meals Clinical examination Good lighting, clean, dry tooth surfaces Buccal lingual/occlusal surfaces all to be checked Record score for the most severe surface in each sextant. Code 0 Code 1 Code 2 Code 3 No ETW Initial loss of enamel Distinct defect, hard Hard tissue loss ≥50% tooth surface texture tissue loss