ADC Practice Question — CMS Fluoride Protocols

How does her fluoride protocol compare to Child A (at-risk, 15 months)?

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 siblings all classified at-risk: Child A is 15 months old. Child B is 4 years old. Child C is 14 years old. The dentist prescribes home fluoride for each. The family does NOT drink fluoridated water. The Low risk child next door is also 15 months old. How does her fluoride protocol compare to Child A (at-risk, 15 months)?

A. Identical — all children under 18 months follow the same fluoride protocol regardless of risk
B. Low risk: no fluoride toothpaste at all. At-risk: 400 ppm twice daily. Risk level changes the under-18-month protocol
C. Low risk: 400 ppm. At-risk: 1000 ppm. Both get toothpaste but at-risk gets higher concentration
D. Low risk: fluoride drops. At-risk: fluoride toothpaste. Different delivery methods for different risk levels

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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

Integration: Table 8 at-risk before 18 months = '400 ppm smear/pea size twice daily.' Table 8 Low before 18 months = 'No fluoride toothpaste.' The SAME AGE can have completely different protocols depending on risk. This is one of the most exam-testable distinctions in the CMS. 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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How does her fluoride protocol compare to Child A (at-risk, 15 months)?

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