ADC Practice Question — CMS Lesion Management Protocols

Primary 85 (ICDAS 3, C3, shadow, 70% root): applying the primary C3 further consideration pathway in order — 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.

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. Primary 85 (ICDAS 3, C3, shadow, 70% root): applying the primary C3 further consideration pathway in order — what is the management?

A. Do not restore — C3 in primary teeth is always managed non-invasively with fluoride varnish only
B. Separate the tooth to confirm cavitation before deciding — shadow alone is insufficient
C. Restore — exfoliation is not imminent (70% root remains), and shadow below marginal ridge satisfies the restoration criterion
D. Extract — C3 with shadow in a primary tooth indicates the tooth is unsalvageable

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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, sequential): Step 1 — within 12 months of exfoliation? No (70% root = >50%). Step 2 — shadow below marginal ridge? YES → restore. Step 3 (separation) is not reached because Step 2 triggered. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 5, C3 further consideration

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

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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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Primary 85 (ICDAS 3, C3, shadow, 70% root): applying the primary C3 further consideration pathway in order — what is the management?

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