ADC Practice Question — CMS Lesion Management Protocols

Given ICDAS 3 with C2 bitewing on tooth 85, the correct management is:

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 5-year-old has primary second molar (tooth 85) with ICDAS Code 3 on occlusal and C2 bitewing radiolucency. dmfs = 1, classified At-risk. Given ICDAS 3 with C2 bitewing on tooth 85, the correct management is:

A. Restore — enamel breakdown in a primary tooth always needs a filling
B. Fluoride varnish only — ICDAS 3 in primary teeth is managed like Code 1-2
C. Extract — a primary molar with breakdown at age 5 will not last to exfoliation
D. Seal with resin or GIC and review in 6 months — BW is not deeper than C3

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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: D

Primary ICDAS 3: 'Restore only if BW extends deeper than C3, otherwise apply sealant or protect with GIC and review in 6 months.' BW is C2, not > C3, so sealant/GIC is correct. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 5

Source: Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 5

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

Exam preparation FAQ

How are CMS Lesion Management Protocols questions structured in the ADC written exam?

ADC CMS Lesion Management Protocols questions present as clinical vignettes requiring management decisions. The correct answer is always traceable to a guideline source.

Should I memorise guidelines word-for-word for CMS Lesion Management Protocols?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

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Given ICDAS 3 with C2 bitewing on tooth 85, the correct management is:

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