ADC Practice Question — CMS Lesion Management Protocols

the bitewing showed C4, what additional factor must be…

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. If the bitewing showed C4, what additional factor must be checked before restoring tooth 85?

A. Whether the child is cooperative enough for local anaesthesia
B. Whether the tooth is nearing exfoliation — less than half root remaining means defer
C. Whether the parent provides consent for a pulpotomy procedure
D. Whether the site-specific Plaque Index score is below 2, which would indicate arrest potential

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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: B

Primary C4/C5: 'Restore now only if tooth is not due to exfoliate.' Clue: less than half of root remains. This exfoliation check is unique to primary teeth. 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 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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the bitewing showed C4, what additional factor must be…

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