Permanent 16 (ICDAS 3, C4 BW, no shadow): applying the…
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.
An 8-year-old at-risk recall boy presents with: Primary tooth 85 — ICDAS 3, C3 bitewing, shadow visible below marginal ridge, 70% root remaining. Permanent tooth 16 — ICDAS 3, C4 bitewing, no shadow visible. Permanent tooth 26 — ICDAS 1 only (visible after 5 seconds air drying). He drinks fluoridated water and uses 1000 ppm toothpaste. Permanent 16 (ICDAS 3, C4 BW, no shadow): applying the permanent tooth protocol — what is the management, and how does the threshold differ from the primary tooth?
- A. Restore with UCSR — C4 in permanent teeth always requires restoration regardless of further consideration
- B. Apply sealant and review in 6 months — because the associated radiolucency does NOT extend deeper than C4, the sealant protocol applies
- C. Restore now — any radiolucency reaching the outer third of dentine requires immediate restoration in children
- D. Separate to confirm cavitation — C4 in permanent teeth follows the same further consideration as primary teeth at C3
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Integration: Table 6 permanent ICDAS 3-4: 'Restore with UCSR only if associated radiolucency extends deeper than C4, otherwise apply resin-based sealant and review in 6 months.' C4 = at threshold, not deeper → sealant. Contrast: primary C3 threshold is LOWER because enamel is thinner. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 6
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