ADC Practice Question — CMS Lesion Management Protocols

For the identical C3 on permanent tooth 36, how does management differ?

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.

A 10-year-old has primary molar 75 with C3 distal radiolucency and 40% root remaining (no marginal ridge shadow). Permanent molar 36 has an identical C3 mesial radiolucency. For the identical C3 on permanent tooth 36, how does management differ?

A. No difference — C3 management is identical for primary and permanent teeth
B. Permanent 36 also triggers further consideration with the same sequential exfoliation and separation checks
C. Permanent 36 is managed with topical fluoride and monitoring — no further consideration at C3
D. Permanent 36 at C3 requires immediate UCSR because permanent teeth cannot be lost

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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

Critical crossover: Primary C3 = 'do not restore without further consideration' (exfoliation, shadow, separation checks). Permanent C3 = simply 'do not restore — topical fluoride and monitor.' The lower primary threshold reflects thinner deciduous enamel and faster dentine progression. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Tables 5 & 6

Source: Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Tables 5 & 6

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Exam preparation FAQ

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.

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.

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For the identical C3 on permanent tooth 36, how does management differ?

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