ADC Practice Question — CMS Lesion Management Protocols

Which clinical action is indicated?

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-year-old at-risk boy has ICDAS Code 4 on tooth 16 mesial with C3 bitewing. A 15-year-old at-risk girl has C4 on tooth 36 distal — tooth separation is not possible. James's tooth 16 shows ICDAS 3-4 with a C3 bitewing. Which clinical action is indicated?

A. UCSR — the ICDAS Code 4 dentine shadow confirms that operative intervention is needed
B. Resin sealant and review in 6 months — BW C3 has not exceeded C4 threshold
C. Fluoride varnish only — ICDAS 3-4 in adolescents needs no physical sealing
D. Extraction and orthodontic planning — this tooth's prognosis is uncertain

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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

Permanent teeth ICDAS 3-4: 'Restore with UCSR only if BW > C4, otherwise resin sealant and review 6 months.' C3 is not > C4 → sealant. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 6

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

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.

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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Which clinical action is indicated?

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