ADC Practice Question — CMS Fluoride Protocols

For an at-risk child before 18 months, what does the CMS prescribe for home fluoride?

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 14-month-old at-risk child with dmfs = 2 and ICDAS > 1 needs a home fluoride protocol. The parent uses no fluoride toothpaste currently, citing the child's young age. For an at-risk child before 18 months, what does the CMS prescribe for home fluoride?

A. No fluoride toothpaste — the under-18-months restriction applies to all risk levels equally
B. 400 ppm fluoride toothpaste, smear/small pea size, twice daily — at-risk starts BEFORE 18 months
C. 1000 ppm fluoride toothpaste immediately — at-risk children need the highest paediatric concentration
D. Fluoride drops instead of toothpaste — oral supplements replace topical fluoride for infants

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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

Key distinction: Low risk = no fluoride toothpaste before 18 months. At-risk = 400 ppm BEFORE 18 months (smear size, twice daily). The risk level changes the age threshold. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 8

Source: Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 8

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

Exam preparation FAQ

How are CMS Fluoride Protocols questions structured in the ADC written exam?

ADC CMS Fluoride Protocols 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 Fluoride Protocols?

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

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