ADC Practice Question — CMS Lesion Management Protocols

For Patient P (Low risk, C4 extending fully 1/3 into dentine, separation not possible): what is the management?

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.

Three adults, each with a C4 radiolucency on the mesial of an upper premolar: Patient P is Low risk (no cavities, BW ≤C4). Patient Q is Medium risk (1 new/year, progressing radiolucencies). Patient R is High risk (frank cavities elsewhere, extensive white spots). Tooth separation is not possible for any patient. The radiolucency on each extends fully one-third into dentine. For Patient P (Low risk, C4 extending fully 1/3 into dentine, separation not possible): what is the management?

A. Do not restore — Low risk C4 is always managed non-invasively regardless of radiolucency depth
B. Restore — the radiolucency extends fully 1/3 through dentine, which satisfies the Low/Medium restoration criterion even without separation
C. Refer for CBCT scan — 2D radiographs cannot reliably assess the 1/3 depth threshold for Low risk C4
D. Apply topical fluoride for 6 months then re-assess — the 1/3 criterion only applies after failed non-invasive therapy

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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

Integration: Table 5 C4 Low/Medium: 'Restore only if radiolucency extends fully 1/3 into dentine OR separation confirms cavitation.' Condition 1 is met (fully 1/3). Separation not possible = irrelevant because depth criterion alone is sufficient. SOURCE — Evans RW et al. CMS for adults, ADJ 2008;53:83-92, Table 5

Source: Evans RW et al. CMS for adults, ADJ 2008;53:83-92, 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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For Patient P (Low risk, C4 extending fully 1/3 into dentine, separation not possible): what is the management?

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