What is the next step?
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 7-year-old At-risk child has primary molar 84 with C3 distal radiolucency. The tooth has 70% root remaining (not near exfoliation). Bitewing shows a shadow visible below the marginal ridge. Primary C3 further consideration: exfoliation is not imminent (70% root). A shadow IS visible below the marginal ridge. What is the next step?
- A. Do not restore — C3 in primary teeth is always managed non-invasively with fluoride only
- B. Restore — shadow below the marginal ridge satisfies the second criterion for restoration
- C. Separate the teeth first — shadow alone is insufficient to justify operative intervention
- D. Place GIC sealant and review in 6 months — the same protocol as ICDAS 3 without shadow
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Primary C3 further consideration (sequential): (1) <12 months to exfoliation? No (70% root). (2) Shadow below marginal ridge? YES → restore. Step 3 (separation) is only reached if steps 1 and 2 are negative. SOURCE — Evans RW, Dennison PJ. CMS for children, ADJ 2009;54:381-389, Table 5, C3 further consideration
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