BEWE
Definition
BEWE is an index for assessing and recording the amount of tooth wear, designed to create a simple, standardized, and repeatable method for clinical examinations. In this system, the mouth is divided into six sextants, and the most severely worn area in each sextant is scored.
The sum of these scores gives an overall picture of the severity of the patient's tooth wear and helps guide decisions about monitoring, prevention, or treatment. BEWE is now one of the most common tools for recording and monitoring tooth wear in both clinical and research settings.
Concept Boundary & Misconceptions
The name "Basic Erosive Wear Examination" creates the impression that BEWE was designed for erosion alone, but this is a misconception; the index records the change in tooth surface regardless of cause. That means it applies the same way to every mechanism of wear, including abrasion and attrition, not just erosion.
The second misconception lies at a diagnostic boundary: cervical caries should not be mistaken for wear. Caries is brown-orange and soft, whereas wear without caries is tooth-colored and hard. When doubt remains about whether a lesion is caries or wear, it should be treated as caries and scored as BEWE zero, not the other way around.
Role in Clinical Decision-Making
Each sextant is scored on a scale of zero to three, and the sum of the six sextants, up to a maximum of 18, sets the patient's risk level and recall interval — from every three years at zero risk to every six months in patients exposed to intrinsic or extrinsic acid. The same protocol, with sextants split into anterior and posterior, also applies to primary teeth, except that because these teeth are more prone to wear, the score is usually higher, and in high-risk cases the recall interval should be shortened to six to twelve months.
But this number does not replace identifying the dominant wear pattern; BEWE was not designed to track the progression of wear over time or to guide the choice of restorative technique — it only tells you how severe the wear is, not why it happened or how it should be treated.
The content of this page is intended for the educational use of dentists and dental students.