ADC Practice Question — Caries risk assessment

Based on this presentation, which statement about the caries status of his remaining molars is most accurate?

Caries risk assessment questions in the ADC written exam test your ability to apply the Caries Management System — risk classification, fluoride protocols, and lesion management. This exam-level vignette tests clinical reasoning, not recall.

A 17-year-old male presents for the first time. He has no restorations except for one filling placed a year ago on his lower right first molar, which has since fallen out. On examination, a small occlusal cavity is visible on the mandibular right second molar. All other occlusal surfaces appear clinically intact. Based on this presentation, which statement about the caries status of his remaining molars is most accurate?

A. The intact occlusal surfaces can be considered caries-free on clinical examination
B. Bitewing radiographs are likely to reveal the true extent of occlusal caries
C. The remaining molars are likely to have undetected occlusal caries despite appearing sound
D. Fissure sealants should be placed on all clinically intact surfaces to prevent future caries

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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

In adolescents, occlusal caries starts on the fissure walls and is obscured by sound superficial enamel. Lesions cavitate late — if at all — because fluoride exposure reinforces the overlying enamel. The small visible cavity on the second molar is a red flag: it suggests the fissure pattern across this patient's molars is susceptible, and other molars are likely to harbour hidden occlusal lesions.

Source: Odell 4th Edition, Case 1: A HIGH CARIES RATE

Remy's study tip — For caries vignettes, classify risk level first — the management decision follows directly from the CMS risk table.

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Build competence across all topics. The exam tests application of guidelines to clinical scenarios, not memorisation.

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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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Based on this presentation, which statement about the caries status of his remaining molars is most accurate?

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