ADC Practice Question — CMS Fluoride Protocols

What is the COMPLETE home care fluoride protocol for this at-risk-high 11-year-old?

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

An 11-year-old at-risk-high recall patient (>1 new lesion/year) currently uses 1000 ppm toothpaste twice daily. He does not use fluoride rinse or CHX. He drinks non-fluoridated water. The dentist must prescribe the COMPLETE updated protocol across all domains. What is the COMPLETE home care fluoride protocol for this at-risk-high 11-year-old? Consider toothpaste, rinse, and CHX.

A. 5000 ppm toothpaste twice daily only — rinse and CHX are reserved for adults with hyposalivation
B. 1000 ppm toothpaste plus fluoride rinse once daily — CHX is contraindicated in children under 16
C. 5000 ppm toothpaste twice daily, fluoride rinse 0.05% NaF once daily at a separate time from brushing, plus CHX 0.2% once daily before bedtime
D. 5000 ppm toothpaste twice daily plus CHX 0.2% twice daily — fluoride rinse is not recommended alongside 5000 ppm

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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

Integration across Table 8 — three columns for at-risk-high 10-17: (1) Toothpaste: 5000 ppm pea size twice daily. (2) Rinse: 0.05% NaF once daily SEPARATE from brushing. (3) CHX: 0.2% once daily BEFORE BEDTIME. Three agents, three timings, one protocol. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 8

Source: Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 8

Remy's study tip — Identify the patient’s risk level first, then match the intervention to the risk.

Exam preparation FAQ

How do I approach an unfamiliar CMS Fluoride Protocols vignette?

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

How should I prepare for Preventive Dentistry & Cariology in the ADC exam?

Build competence across all topics. The exam tests application of guidelines to clinical scenarios, not memorisation.

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What is the COMPLETE home care fluoride protocol for this at-risk-high 11-year-old?

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