ADC Practice Question — CMS Fluoride Protocols

For this at-risk-high child, should professional varnish application sites differ from a standard at-risk child?

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.

An 11-year-old at-risk-high boy with >1 new lesion/year is currently using 1000 ppm toothpaste. The dentist needs to upgrade his full protocol. The parent asks about when to use the rinse and CHX. For this at-risk-high child, should professional varnish application sites differ from a standard at-risk child?

A. Yes — at-risk-high receives varnish on every surface of every tooth at each visit
B. No — both at-risk and at-risk-high follow the same professional varnish protocol in Table 7
C. Yes — at-risk-high adds buccal and lingual surfaces beyond the occlusal and approximal
D. No — at-risk-high children do not receive professional varnish since CHX replaces it

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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

Table 7 professional varnish protocol applies to all 'At-risk' children without sub-division by High status. The at-risk-high distinction affects HOME care (5000 ppm, rinse, CHX) but not professional application. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Tables 7 & 8

Source: Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Tables 7 & 8

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

Exam preparation FAQ

How do I approach an unfamiliar CMS Fluoride Protocols vignette?

Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

How should I prepare for Preventive Dentistry & Cariology in the ADC exam?

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For this at-risk-high child, should professional varnish application sites differ from a standard at-risk child?

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