What professional fluoride should this patient receive, and how does it differ from a standard at-risk child's professional care?
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.
An 11-year-old at-risk-high recall patient (>1 new lesion/year) currently uses 1000 ppm toothpaste twice daily. He does not use fluoride rinse or CHX. He drinks non-fluoridated water. The dentist must prescribe the COMPLETE updated protocol across all domains. What professional fluoride should this patient receive, and how does it differ from a standard at-risk child's professional care?
- A. At-risk-high receives varnish on every surface of every tooth at each visit — much broader coverage than standard at-risk
- B. At-risk-high receives fluoride gel instead of varnish — gel is more potent for severe cases
- C. Both receive the same professional protocol — varnish or GIC on erupting molars plus varnish on all lesion surfaces at every treatment and recall session
- D. At-risk-high does not receive professional fluoride — CHX replaces all fluoride applications in the highest-risk protocol
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Integration: (1) Table 7 has only one 'At-risk' row — no At-risk-High subdivision for professional care. (2) Professional protocol: varnish/GIC on erupting molars + varnish on lesions + homologous teeth at every session. (3) The At-risk-High distinction affects HOME care (Table 8), not professional care (Table 7). SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Tables 7 & 8
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