ADC Practice Question — CMS Lesion Management Protocols

For Chloe's C4 on tooth 36 where separation is not possible, when should she be restored?

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-year-old at-risk boy has ICDAS Code 4 on tooth 16 mesial with C3 bitewing. A 15-year-old at-risk girl has C4 on tooth 36 distal — tooth separation is not possible. For Chloe's C4 on tooth 36 where separation is not possible, when should she be restored?

A. Immediately — inability to separate defaults to operative intervention
B. Never — C4 in adolescent permanent teeth is always managed non-invasively
C. After 6 months if the radiolucency has not regressed following intensive fluoride
D. Only if the radiolucency extends fully one-third through the dentine thickness

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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: D

Permanent C4 further consideration: if separation possible → restore only if cavitated. If not → restore only if radiolucency extends fully 1/3 through dentine. Otherwise do not restore. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 6, C4 further consideration

Source: Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 6

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 Lesion Management 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?

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

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For Chloe's C4 on tooth 36 where separation is not possible, when should she be restored?

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