ADC Practice Question — CMS Lesion Classification & Diagnosis

Is this ICDAS Code 1 or fluorosis?

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 10-year-old's examination: Tooth 36 buccal has a brown spot visible when the surface is wet. Tooth 46 shows a blue-grey shadow visible through the enamel on the mesial marginal ridge. A fluoridated community child has white flecks along ridges and cusps but the fissure base appears normal and translucent. Is this ICDAS Code 1 or fluorosis?

A. ICDAS Code 1 — all white marks on teeth should be coded as early caries regardless of location
B. Fluorosis — fluorotic flecks on ridges/cusps with normal translucent fissure base distinguish from caries
C. Cannot differentiate — clinical examination alone cannot distinguish fluorosis from caries
D. Neither — white flecks are only significant if they are visible after air drying exclusively

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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

CMS: 'fluorotic flecks predominantly at sites where enamel is thicker (ridges, cusps) but not within fissure depths. The caries lesion initiates beneath plaque at the fissure BASE.' This is why Code 1 is excluded — fluorosis confusion. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Discussion, p.388

Source: Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, p.388

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Exam preparation FAQ

How do I approach an unfamiliar CMS Lesion Classification & Diagnosis 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?

Build competence across all topics. The exam tests application of guidelines to clinical scenarios, not memorisation.

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