Jerоme is а 44-yeаr-оld mаle that presents tо the clinic on referral from his PCP. He has been on fluoxetine (Prozac) for over 20 years and notes more recently his depression is coming back without any real trigger and feeling more apathetic. When thinking about how medications work and the potential of “pooping out” you discuss with him:
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Cаse # AL -Addie Lessent is а 14 yeаr-оld female. She has cоme in fоr her six-month recall appointment. Medical history indicates seasonal allergies and mild exercise-induced asthma. She is taking Zyrtec (antihistamine) daily and uses her inhaler only before strenuous physical activity. VS are BP 112/76, P 78, R 16. EIE reveals mild enamel hypoplasia of the permanent first molars and a composite restoration in the mesial pit of the occlusal of #14. She has orthodontic brackets on #4 - #13, orthodontic bands on #3 and #14 with an arch wire on the facials. There is generalized erythema and edema of the free gingival margin and heavy plaque on the cervical thirds of all teeth and surrounding the bands and brackets. Probe readings on permanent first molars and permanent incisors range from 1-3 mm with generalized bleeding and localized hemorrhaging. Moderate supragingival calculus is present on the lower anterior lingual surfaces. Permanent molars have deep fissures; #19 has a gray shadow underneath the enamel on the mesial aspect. Bitewing radiographs reveal decay on the mesial of #19. The dentist recommends dental sealants be done at this visit on all permanent molars except #19.QUESTION: Of the following ICDAS (International Caries Detection and Assessment System) classifications, which one would be applied to the findings referred to in the case assessment regarding tooth #19?