For Patient R (High risk, same C4): is the management different, and if so, how?
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.
Three adults, each with a C4 radiolucency on the mesial of an upper premolar: Patient P is Low risk (no cavities, BW ≤C4). Patient Q is Medium risk (1 new/year, progressing radiolucencies). Patient R is High risk (frank cavities elsewhere, extensive white spots). Tooth separation is not possible for any patient. The radiolucency on each extends fully one-third into dentine. For Patient R (High risk, same C4): is the management different, and if so, how?
- A. Identical to Patient P — C4 management does not vary by risk level in the CMS
- B. Different — High risk C4: restore now, without the further consideration steps that Low/Medium patients receive
- C. Different — High risk C4 requires extraction and implant replacement rather than restoration
- D. Different — High risk C4 requires root canal treatment before restoration to prevent pulp complications
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Integration: Table 5 C4 splits: HIGH = 'Restore now' (no further consideration). LOW/MEDIUM = 'Restore only if 1/3 into dentine or separation confirms cavitation.' Same tooth, same BW, completely different decision pathway based solely on risk classification. SOURCE — Evans RW et al. CMS for adults, ADJ 2008;53:83-92, Table 5
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