ADC Practice Question — Caries risk assessment

What is the most appropriate management of this softened dentine?

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 has deep occlusal caries in several molars. During caries removal in one molar, the deepest layer of dentine over the pulp feels slightly soft. There is no staining at this depth. The patient has reported no symptoms of pulpitis from this tooth. What is the most appropriate management of this softened dentine?

A. Remove all softened dentine completely — leaving any soft dentine risks restoration failure
B. Leave the slightly soft dentine in place and seal with a well-adapted restoration
C. Apply calcium hydroxide to the softened dentine, then place a temporary restoration and review in 6 weeks
D. Perform elective endodontic treatment to eliminate any risk of future pulp pathology

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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

The deepest layers of rapidly advancing caries can be soft through demineralisation but are not necessarily infected. Bacterial penetration is not reliably indicated by staining in rapidly advancing lesions. Slightly soft dentine can be left over the pulp provided a good, well-sealed restoration is placed. Very soft or flaky dentine must always be removed — but "slightly soft" in an asymptomatic tooth without staining can be preserved.

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.

Exam preparation FAQ

How do I approach an unfamiliar Caries risk assessment vignette?

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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