ADC Practice Question — CMS Risk Assessment & Classification

For the C4 on tooth 46 in this High risk patient, what is the management and how does it differ from what a Low risk patient would receive?

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 42-year-old new patient presents with: one untreated frank cavity on tooth 36, a C4 radiolucency on mesial of tooth 46, C3 on distal of tooth 16, extensive white spot lesions on buccal surfaces of 13-23, and stimulated saliva flow of 0.8 mL per 2 minutes. She uses 1000 ppm toothpaste twice daily. For the C4 on tooth 46 in this High risk patient, what is the management and how does it differ from what a Low risk patient would receive?

A. Both High and Low risk: restore only if separation confirms cavitation — the C4 protocol is identical across all risk levels
B. High risk: restore now without further consideration. Low risk: restore only if fully 1/3 into dentine or separation confirms cavitation
C. High risk: apply fluoride and monitor. Low risk: restore immediately — lower risk patients tolerate operative care better
D. Both: do not restore without further consideration — C4 management is always the same risk-stratified protocol

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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: B

Integration: Table 5 C4 branch splits by risk: HIGH = 'restore now' + fluoride for prevention. LOW/MEDIUM = 'restore only if fully 1/3 into dentine or separation confirms cavitation; otherwise do not restore.' Risk changes the OPERATIVE decision. SOURCE — Evans RW et al. CMS for adults, ADJ 2008;53:83-92, Table 5

Source: Evans RW et al. CMS for adults, ADJ 2008;53:83-92, Table 5

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

Exam preparation FAQ

How are CMS Risk Assessment & Classification questions structured in the ADC written exam?

ADC CMS Risk Assessment & Classification 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 Risk Assessment & Classification?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

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For the C4 on tooth 46 in this High risk patient, what is the management and how does it differ from what a Low risk patient would receive?

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