ADC Practice Question — CMS Risk Assessment & Classification

What is this patient's risk classification, and which single finding would be sufficient on its own to reach it?

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.

A 42-year-old new patient presents with: one untreated frank cavity on tooth 36, a C4 radiolucency on mesial of tooth 46, C3 on distal of tooth 16, extensive white spot lesions on buccal surfaces of 13-23, and stimulated saliva flow of 0.8 mL per 2 minutes. She uses 1000 ppm toothpaste twice daily. What is this patient's risk classification, and which single finding would be sufficient on its own to reach it?

A. Medium — the C4 radiolucency is the highest-severity finding and Medium allows up to C4
B. High — any ONE of: frank cavity, extensive white spots, or C5 would individually trigger High; she has TWO
C. High — but only because the frank cavity AND extensive white spots are present together; neither alone qualifies
D. Medium — frank cavities are not a risk factor in the CMS; only radiographic findings determine classification

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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 4 High = (1) untreated frank cavities, AND/OR (2) extensive white spots, AND/OR (3) C5. This patient has TWO independent High criteria (frank cavity + extensive white spots). The C4 is lower-severity and doesn't change the classification. SOURCE — Evans RW et al. CMS for adults, ADJ 2008;53:83-92, Table 4

Source: Evans RW et al. CMS for adults, ADJ 2008;53:83-92, Table 4

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

Exam preparation FAQ

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.

How do I approach an unfamiliar CMS Risk Assessment & Classification vignette?

Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

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What is this patient's risk classification, and which single finding would be sufficient on its own to reach it?

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