ADC Practice Question — CMS Risk Assessment & Classification

Does this finding change the child's overall risk classification or clinical management?

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 8-year-old at-risk recall boy presents with: Primary tooth 85 — ICDAS 3, C3 bitewing, shadow visible below marginal ridge, 70% root remaining. Permanent tooth 16 — ICDAS 3, C4 bitewing, no shadow visible. Permanent tooth 26 — ICDAS 1 only (visible after 5 seconds air drying). He drinks fluoridated water and uses 1000 ppm toothpaste. Permanent 26 shows ICDAS 1 only. Does this finding change the child's overall risk classification or clinical management?

A. Yes — ICDAS 1 adds to the lesion count and may escalate the child from at-risk to at-risk-high
B. Yes — ICDAS 1 confirms active caries on a newly erupted tooth requiring immediate fluoride varnish application
C. No — ICDAS Code 1 is NOT used for risk classification because it may be unreliable and confused with fluorosis
D. No — but only because the child already has other at-risk findings that make ICDAS 1 redundant

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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: C

Integration: (1) ICDAS 1 = visible only after 5s air drying. (2) 'Not considered to indicate a higher than low risk rating mainly because they may not be diagnosed reliably.' (3) 'Small fluorotic signs might also be mistakenly assigned Code 1.' (4) This finding changes NOTHING about risk or management. 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

Remy's study tip — Identify the patient’s risk level first, then match the intervention to the risk.

Exam preparation FAQ

How are CMS Risk Assessment & Classification questions structured in the ADC written exam?

ADC CMS Risk Assessment & Classification 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 Risk Assessment & Classification?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

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Does this finding change the child's overall risk classification or clinical management?

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