ADC Practice Question — CMS Lesion Management Protocols

For permanent 36 (ICDAS level consistent with C3 BW): what is the management, and why is it DIFFERENT from the primary tooth?

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 9-year-old has two teeth with identical bitewing findings: C3 radiolucency. Primary tooth 84 has 80% root remaining and no shadow below the marginal ridge. Permanent tooth 36 has the same C3 without shadow. The dentist must apply two DIFFERENT protocols. For permanent 36 (ICDAS level consistent with C3 BW): what is the management, and why is it DIFFERENT from the primary tooth?

A. Same as primary — separate to confirm cavitation; the C3 protocol is identical across tooth types
B. Do not restore — C3 in permanent teeth is managed with topical fluoride and monitoring only, because thicker enamel means cavitation is less likely
C. Restore with UCSR — any radiolucency reaching the DEJ in permanent teeth requires operative management
D. Apply resin-based sealant and review in 6 months — the permanent protocol for ICDAS 3 with BW not exceeding C4

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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: D

Integration: (1) Permanent ICDAS 3-4 with BW not deeper than C4: 'sealant and review in 6 months' (Table 6). (2) Primary C3: further consideration pathway (Table 5). (3) DIFFERENT because of enamel thickness — thinner primary enamel means lower threshold for operative care. (4) Same BW finding, completely different management. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Tables 5 & 6, p.388

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

Remy's study tip — Identify the patient’s risk level first, then match the intervention to the risk.

Exam preparation FAQ

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.

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.

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For permanent 36 (ICDAS level consistent with C3 BW): what is the management, and why is it DIFFERENT from the primary tooth?

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