For an at-risk child before 18 months, what does the…
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 14-month-old at-risk child with dmfs = 2 and ICDAS > 1 needs a home fluoride protocol. The parent uses no fluoride toothpaste currently, citing the child's young age. For an at-risk child before 18 months, what does the CMS prescribe for home fluoride?
- A. No fluoride toothpaste — the under-18-months restriction applies to all risk levels equally
- B. 400 ppm fluoride toothpaste, smear/small pea size, twice daily — at-risk starts BEFORE 18 months
- C. 1000 ppm fluoride toothpaste immediately — at-risk children need the highest paediatric concentration
- D. Fluoride drops instead of toothpaste — oral supplements replace topical fluoride for infants
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Key distinction: Low risk = no fluoride toothpaste before 18 months. At-risk = 400 ppm BEFORE 18 months (smear size, twice daily). The risk level changes the age threshold. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 8
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