Why does the permanent tooth management table use C4…
Prevention and cariology questions test evidence-based decision-making — fluoride protocols, caries risk assessment, recall scheduling. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.
A 13-year-old At-risk boy has permanent tooth 16 with ICDAS 5 and C5 bitewing. Tooth 26 has ICDAS 3 and C4 bitewing. Tooth 36 has a pit/fissure lesion with enamel breakdown where moisture control is adequate. Why does the permanent tooth management table use C4 as the 'further consideration' threshold, while primary teeth use C3?
- A. Because permanent teeth have thicker enamel — lesions take longer to reach critical depth
- B. Because the adult CMS protocol overrides the children's protocol for permanent teeth
- C. Because primary teeth are less important and can tolerate earlier operative intervention
- D. Because permanent tooth radiolucencies are always less accurate than primary tooth readings
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CMS: 'enamel in deciduous teeth is less than on corresponding sites of permanent teeth — increased risk of cavity extension into dentine, at which stage risk of pulp exposure is elevated.' Thinner enamel → lower threshold. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, p.388
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