Early Caries Management — ORE Part 1 MCQ

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EasyDental Public Health & EpidemiologyEarly Caries ManagementORE Part 1

A child has a non-cavitated white-spot lesion confined to enamel in the occlusal fissure of a permanent first molar. According to current UK guidance, which is the most appropriate management?

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Correct answer: D — Give preventive advice, apply fluoride varnish and seal the fissure

**A is correct.** A white-spot lesion confined to enamel is an initial, non-cavitated carious lesion. SDCEP advises use of the least invasive feasible strategy for permanent teeth. For an initial occlusal lesion in a permanent tooth, fissure sealing without caries removal is suitable and can slow or arrest lesion progression. It should be combined with active prevention: dietary sugar advice, effective fluoride toothbrushing and professionally applied fluoride varnish. **B** includes prevention but omits sealing of the susceptible fissure; surveillance remains necessary, but prevention plus sealing is the best option offered. **C** and **D** are unnecessarily destructive because the lesion is non-cavitated and does not require operative excavation. **E** is grossly inappropriate for a reversible enamel lesion in a permanent first molar.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Prevention and Management of Dental Caries in Children, 3rd edition (February 2025), “Sealant/infiltration”. https://www.childcaries.sdcep.org.uk/guidance/dental-techniques/sealantinfiltration/