We need to act now to identify and manage erosive tooth wear

News Published: 
25 July 2019

FGDP(UK) Dean, Ian Mills, discusses the importance of early identification and treatment of erosive tooth wear.

At the end of last year, I represented FGDP(UK) at a round table discussion which brought together key dental bodies to consider the impact of erosive tooth wear and the role of the BEWE examination as part of every oral health assessment. This month, a press event was held at King’s College London to launch the campaign to raise awareness amongst the profession, from dental students to established dental professionals, of the need to act to identify signs of erosive tooth wear and counsel patients on the potential impacts and their role in prevention of the condition.

So why is it important to identify erosive tooth wear? 

Erosive tooth wear is the third most commonly observed oral condition1 and refers to the combination of erosion with physical wear.2 The nature of the condition means that it usually affects clean, plaque free surfaces; a group who may consider they are proactive in their oral care. Although rate of progression is slow, it can have major impacts for patients if allowed to progress both in terms of aesthetics, function and cost. The combination of these factors could lead to consideration that erosive tooth wear could be a future litigation risk for the profession.

What can we do as a profession?

  1. It is important to be aware of the risks of erosive tooth wear and proactively assess patients for signs of the condition. The Basic Erosive Wear Examination or BEWE is a simple index which can be undertaken at the same time as the BPE. It is important that the BEWE is completed, implications of scores are discussed with the patient and importantly that findings are recorded within the clinical record as stated in FGDP(UK)'s Clinical Examination and Record Keeping guidance.3 The key teeth to watch are the maxillary central incisors and the lower first molars4. Click here to view the video demonstration of BEWE with Professor David Bartlett.
  2. If signs are identified it is important to ensure that your patient understands their role in prevention of further damage. This condition is best managed with limited intervention. Dependent on the source of the acidic challenge, the best course is to identify and manage risk factors.
  3. One of the key messages to stress to patients is that healthy foods which may be acidic should not be avoided. A simple change would be to consume these foods, such as oranges, apples or fruit juice with meals as opposed to between meals. Research shows that each additional acidic challenge outside of meal times significantly increases the risk of erosive tooth wear.5

Over the next few months FGDP(UK) will be working in partnership with King’s College London, BSDHT, Dental Protection, The Erosive Tooth Wear Foundation and GSK to raise awareness of the new campaign. Further information about erosive tooth wear and the use of the BEWE can be found online at www.erosivetoothwear.com. 


Ian Mills is a general dental practitioner in a mixed NHS-and-private practice in North Devon. Read more of his posts at www.fgdp.org.uk/deans-blog.








  1. Bartlett et al. Prevalence of tooth wear on buccal and lingual surfaces & possible risk factors in young European adults. J Dent 2013; 41: 1007-1013
  2. Bartlett D. Personal perspective and update on erosive tooth wear – 10 years on. Part 1: Diagnosis. BDJ Vol 221. No.3. August 2016
  3. Clinical Examination & Record-Keeping. Faculty of General Dental Practice (UK). Available to access online at https://www.fgdp.org.uk/guidance-standards/clinical-examination-and-record-keeping-0 
  4. Erosive tooth wear foundation. https://www.erosivetoothwear.com/health-professionals
  5. O’Toole S et al. Journal of Dentistry. 2017; 56: 99-104

Erosive tooth wear image featured in Bites kindly supplied by Professor David Bartlett, Kings College London