ADC Practice Question — CMS Risk Assessment & Classification

For Patient R (High risk, same C4): is the management different, and if so, how?

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.

Three adults, each with a C4 radiolucency on the mesial of an upper premolar: Patient P is Low risk (no cavities, BW ≤C4). Patient Q is Medium risk (1 new/year, progressing radiolucencies). Patient R is High risk (frank cavities elsewhere, extensive white spots). Tooth separation is not possible for any patient. The radiolucency on each extends fully one-third into dentine. For Patient R (High risk, same C4): is the management different, and if so, how?

A. Identical to Patient P — C4 management does not vary by risk level in the CMS
B. Different — High risk C4: restore now, without the further consideration steps that Low/Medium patients receive
C. Different — High risk C4 requires extraction and implant replacement rather than restoration
D. Different — High risk C4 requires root canal treatment before restoration to prevent pulp complications

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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

Integration: Table 5 C4 splits: HIGH = 'Restore now' (no further consideration). LOW/MEDIUM = 'Restore only if 1/3 into dentine or separation confirms cavitation.' Same tooth, same BW, completely different decision pathway based solely on risk classification. SOURCE — Evans RW et al. CMS for adults, ADJ 2008;53:83-92, Table 5

Source: Evans RW et al. CMS for adults, ADJ 2008;53:83-92, Table 5

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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For Patient R (High risk, same C4): is the management different, and if so, how?

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