Dual Prevention Approach — ORE Part 1 MCQ

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ModerateDental Public Health & EpidemiologyDual Prevention ApproachORE Part 1

A child presents with early enamel caries (white spot lesion) on the buccal surface of a recently erupted lower first permanent molar. The child has poor oral hygiene and high caries risk. In addition to fluoride varnish application, what other professional preventive intervention is most appropriate for this tooth?

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Correct answer: D — Apply a resin fissure sealant to the pits and fissures of the same tooth

Explanation lettering: C = shown as A · D = shown as C · A = shown as D

The correct answer is A. In a high-caries-risk child with poor oral hygiene and an existing white spot lesion on a recently erupted lower first permanent molar, UK guidance (SDCEP and Delivering Better Oral Health) recommends a dual preventive strategy: fluoride varnish arrests the buccal lesion through remineralisation; a resin fissure sealant prevents occlusal caries. SDCEP explicitly supports sealant placement alongside fluoride varnish when caries is already present and oral hygiene is poor. Extraction (B) is unjustified for a non-cavitated lesion. Immediate composite restoration (C) is unnecessary because the white spot can remineralise with fluoride, and restoration is invasive. A stainless steel crown (D) is grossly disproportionate. No additional intervention (E) leaves the occlusal surfaces unprotected in a high-risk child, contrary to guidance.

Reference: SDCEP (2025). Prevention and Management of Dental Caries in Children: Professionally-delivered interventions. https://www.childcaries.sdcep.org.uk/guidance/caries-prevention/professionally-delivered-interventions/ AND UK Department of Health & Social Care (2025). Delivering Better Oral Health: Chapter 4 – Dental Caries. https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-4-dental-caries