ADC Practice Question — CMS Lesion Management Protocols

For primary 84 (C3, no shadow, 80% root, no imminent exfoliation): the further consideration pathway leads to what step?

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 primary 84 (C3, no shadow, 80% root, no imminent exfoliation): the further consideration pathway leads to what step?

A. Apply fluoride varnish and monitor — C3 without shadow is managed conservatively in primary teeth
B. Restore immediately — C3 in primary teeth always requires operative intervention
C. Separate the tooth to confirm cavitation — restore only if cavitated; this is step 3 after exfoliation and shadow checks fail
D. Place GIC sealant and review in 6 months — the same protocol as the permanent tooth

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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: C

Integration: Primary C3 further consideration (Table 5): Step 1 — exfoliation within 12 months? No (80% root). Step 2 — shadow below marginal ridge? No. Step 3 — 'separate tooth to confirm cavitation and restore ONLY if cavitated.' Three sequential checks. 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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For primary 84 (C3, no shadow, 80% root, no imminent exfoliation): the further consideration pathway leads to what step?

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