ADC Practice Question — CMS Lesion Management Protocols

Why does the CMS use lower restoration thresholds for primary teeth than permanent teeth?

Prevention and cariology questions test evidence-based decision-making — fluoride protocols, caries risk assessment, recall scheduling. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

A dentist places a sealant on a partially erupted lower second permanent molar in a 12-year-old. Isolation is difficult due to an operculum. ICDAS Code 3 lesion in fissures. Why does the CMS use lower restoration thresholds for primary teeth than permanent teeth?

A. Primary teeth have relatively larger pulp chambers in proportion to crown size requiring earlier intervention
B. Parents prefer definitive treatment of primary teeth over extended monitoring
C. Deciduous enamel is thinner, increasing the risk of rapid cavity extension into dentine
D. Primary teeth are functionally less important, so restoration can occur earlier

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: C

CMS: 'enamel in deciduous teeth is less than on corresponding sites of permanent teeth and hence is associated with increased risk of cavity extension into dentine, at which stage risk of pulp exposure associated with operative intervention is elevated.' SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, p.388

Source: Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, p.388

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Exam preparation FAQ

How do I approach an unfamiliar CMS Lesion Management Protocols vignette?

Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

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