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INBDE practice questions

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Question 1Diagnosis and Treatment Planning

A 34-year-old patient says, "My upper right tooth hurts when I drink cold water." How should this statement be recorded?

  1. Recorded in the patient's own words Correct answer.
  2. As the dentist's interpretation of the symptoms
  3. As a definitive diagnosis of irreversible pulpitis
  4. As a list of the restorative treatment needed

Explanation

The chief complaint is recorded verbatim in the patient's own words because it is a symptom report that guides, but does not replace, the diagnostic process. Interpretation and diagnosis belong in the assessment section after a complete examination.

Question 2Diagnosis and Treatment Planning

A patient's blood pressure is 148/94 mmHg on two separate visits. Using standard adult categories, this reading represents:

  1. Stage 2 hypertension Correct answer.
  2. Elevated blood pressure
  3. Normal blood pressure
  4. Stage 1 hypertension

Explanation

Stage 2 hypertension is defined as systolic pressure of 140 mmHg or higher, or diastolic pressure of 90 mmHg or higher. This reading exceeds both thresholds, so it falls in the stage 2 category.

Question 3Diagnosis and Treatment Planning

What is the most important reason to obtain a complete medical history before dental treatment?

  1. To establish the patient's recall interval
  2. To decide which radiographs to obtain
  3. To determine the patient's insurance coverage
  4. To identify conditions that alter dental care Correct answer.

Explanation

The medical history identifies systemic disease, medications, allergies, and prior adverse events that modify treatment, drug selection, hemostasis, and emergency management. Radiographic selection and recall intervals are subsequently tailored to these findings.

Question 4Diagnosis and Treatment Planning

A patient reports an audible click in the right temporomandibular joint with no pain, no locking, and normal mandibular range of motion. What is the most appropriate initial management?

  1. Immediate magnetic resonance imaging
  2. Surgical consultation
  3. Observation and reassurance Correct answer.
  4. Irreversible occlusal splint therapy for six months

Explanation

Asymptomatic joint clicking with normal function is a common finding that generally requires no active intervention. Treatment should be conservative and reversible, with imaging or surgery reserved for pain, functional limitation, or suspected pathology.

Question 5Diagnosis and Treatment Planning

When the gingival margin lies apical to the cementoenamel junction, which measurement best reflects past periodontal destruction?

  1. Bleeding on probing
  2. Clinical attachment level Correct answer.
  3. Gingival index
  4. Probing depth

Explanation

Clinical attachment level is measured from the cementoenamel junction to the base of the sulcus and therefore accounts for recession, documenting cumulative attachment loss. Probing depth alone can appear unchanged while the attachment apparatus is being destroyed.

Question 6Diagnosis and Treatment Planning

A well-defined, corticated radiolucency surrounds the apex of a nonvital mandibular premolar. What is the most likely diagnosis?

  1. Periapical cyst Correct answer.
  2. Osteomyelitis
  3. Normal trabecular pattern
  4. Osteosarcoma

Explanation

A corticated, well-circumscribed radiolucency at the apex of a necrotic tooth is most consistent with a radicular (periapical) cyst or apical granuloma. Definitive distinction requires histopathology, but the radiographic appearance strongly favors a cyst.

Question 7Diagnosis and Treatment Planning

A mandibular first molar with a deep restoration does not respond to cold testing, while adjacent teeth respond normally. The tooth is asymptomatic. What does this most likely indicate?

  1. Reversible pulpitis
  2. Irreversible pulpitis
  3. Pulp necrosis Correct answer.
  4. Normal pulpal health

Explanation

Absence of a response to thermal stimulation in a tooth with deep caries or restoration suggests loss of vital pulp tissue, consistent with necrosis. Because false-negative responses can occur, the result is confirmed with electric pulp testing and percussion.

Question 8Diagnosis and Treatment Planning

A patient has a painful ulcer on the lateral tongue of three days' duration with a yellow fibrin center and an erythematous halo, occurring after accidentally biting the tongue. What is the most likely diagnosis?

  1. Squamous cell carcinoma
  2. Syphilitic chancre
  3. Erythema multiforme
  4. Traumatic ulcer Correct answer.

Explanation

An acute, painful ulcer with a fibrin center and red halo at a site of identifiable trauma is characteristic of a traumatic ulcer. Such lesions normally heal within two weeks, and persistence beyond that point requires biopsy.

Question 9Diagnosis and Treatment Planning

A patient has well-controlled type 2 diabetes with an HbA1c of 6.8% and no other medical conditions. How is this patient classified?

  1. ASA II Correct answer.
  2. ASA I
  3. ASA IV
  4. ASA III

Explanation

ASA II designates a patient with mild systemic disease that does not limit activity, which fits well-controlled diabetes. ASA I would require a completely healthy patient.

Question 10Diagnosis and Treatment Planning

Which patient requires antibiotic prophylaxis before invasive dental procedures?

  1. A patient with mitral valve prolapse without regurgitation
  2. A patient with a coronary artery stent
  3. History of infective endocarditis Correct answer.
  4. A patient with a pacemaker

Explanation

Current prophylaxis indications include a history of infective endocarditis, prosthetic cardiac valves or material, unrepaired cyanotic congenital heart disease, repaired congenital defects with residual defects, and valvulopathy after cardiac transplantation. A prior episode of endocarditis carries a particularly high recurrence risk.

Question 11Diagnosis and Treatment Planning

In which situation is limited-field cone beam computed tomography most clearly justified?

  1. Replacement for bitewing radiographs in a patient with multiple carious lesions
  2. Suspected buccal plate perforation before implant placement Correct answer.
  3. Initial evaluation of a child's mixed dentition
  4. Routine caries screening in a low-risk adult

Explanation

Cone beam computed tomography is justified when two-dimensional imaging cannot answer the clinical question and the field of view can be limited to the region of interest. Bone thickness and cortical plate integrity around an implant site are typical indications.

Question 12Diagnosis and Treatment Planning

A patient taking warfarin has an INR of 2.5 and requires extraction of a periodically hopeless tooth. What is the most appropriate management?

  1. Proceed with local hemostatic measures Correct answer.
  2. Refer to the hospital for fresh frozen plasma
  3. Stop warfarin five days before the appointment
  4. Reduce the warfarin dose by half before surgery

Explanation

An INR within the therapeutic range for most indications (up to about 3.5) is generally acceptable for simple extraction, and the anticoagulant should not be interrupted. Local measures such as sutures, pressure packs, and hemostatic agents control bleeding.

Question 13Diagnosis and Treatment Planning

Which element is essential for informed consent to be valid?

  1. A guarantee of successful treatment
  2. A signature from the patient's employer
  3. Discussion of risks, benefits, and alternatives Correct answer.
  4. Written clearance from the patient's physician

Explanation

Valid informed consent requires a patient with decision-making capacity who voluntarily agrees after disclosure of the nature of the procedure, its material risks and benefits, and reasonable alternatives including no treatment. Documentation supports, but does not create, the consent.

Question 14Diagnosis and Treatment Planning

How is tell-show-do best described?

  1. Local anesthesia technique
  2. Radiographic technique
  3. Caries risk assessment tool
  4. Behavior guidance method Correct answer.

Explanation

Tell-show-do is a behavior guidance strategy in which the procedure is explained in child-friendly language, demonstrated, and then performed. It reduces anxiety and builds trust, particularly in pediatric and anxious adult patients.

Question 15Diagnosis and Treatment Planning

A patient has an acute facial swelling of odontogenic origin, uncontrolled pain, and multiple carious teeth. What is the first priority in the treatment plan?

  1. Comprehensive restorative treatment plan
  2. Emergency control of infection and pain Correct answer.
  3. Orthodontic and prosthodontic consult
  4. Full-mouth periodontal therapy

Explanation

Treatment planning proceeds in phases, beginning with urgent and emergency care such as airway assessment, drainage of infection, and pain control. Definitive restorative and periodontal care is sequenced only after the acute problem is resolved and disease is controlled.

Question 16Diagnosis and Treatment Planning

An ulcer on the ventral surface of the tongue has persisted for three weeks despite removal of an irritating denture border. What is the next best step?

  1. Prescribe a topical corticosteroid and review in four weeks
  2. Prescribe a course of antibiotics
  3. Reassure the patient and review in six months
  4. Perform or refer for biopsy Correct answer.

Explanation

Any oral ulcer that persists beyond two weeks after removal of an identified cause must be considered suspicious for malignancy and warrants biopsy. Delay in diagnosis is the main factor that worsens outcomes in oral squamous cell carcinoma.

Question 17Diagnosis and Treatment Planning

Which finding most strongly increases a patient's risk of developing new caries?

  1. Daily flossing
  2. Fluoridated community water supply
  3. A single amalgam restoration placed 10 years ago
  4. Active caries in the past 12 months Correct answer.

Explanation

Recent caries experience is the strongest single predictor of future caries, because it reflects an ongoing unfavorable balance between demineralization and remineralization. Protective factors such as fluoride, flossing, and old stable restorations lower rather than raise risk.

Question 18Diagnosis and Treatment Planning

Which is the most important modifiable risk factor for both oral squamous cell carcinoma and periodontal disease?

  1. Age
  2. Genetic predisposition
  3. Tobacco use Correct answer.
  4. Male sex

Explanation

Tobacco use is a major dose-dependent risk factor for oral cancer and also impairs neutrophil function, vasoconstricts gingival tissues, and worsens periodontal attachment loss. Because it is modifiable, cessation counseling is a core part of risk reduction.

Question 19Diagnosis and Treatment Planning

A healthy 70 kg adult is to receive 2% lidocaine with 1:100,000 epinephrine. What is the maximum recommended dose of lidocaine?

  1. 1,400 mg
  2. 70 mg
  3. 490 mg Correct answer.
  4. 150 mg

Explanation

The maximum recommended dose of lidocaine is about 7 mg/kg, not to exceed an absolute ceiling of roughly 500 mg. For a 70 kg adult, 70 × 7 = 490 mg, which corresponds to about 24 mL of a 2% solution (20 mg/mL).

Question 20Diagnosis and Treatment Planning

A patient taking nifedipine presents with generalized gingival enlargement. What is the most appropriate initial management?

  1. Extraction of all involved teeth
  2. Immediate gingivectomy
  3. Plaque control and physician consultation Correct answer.
  4. Change the antihypertensive without consultation

Explanation

Drug-influenced gingival enlargement is worsened by plaque, so meticulous oral hygiene and nonsurgical periodontal therapy are the first steps. The prescribing physician may consider an alternative agent, but the dentist must never alter another clinician's prescription unilaterally.

Question 21Diagnosis and Treatment Planning

A 60-year-old patient has a firm, fixed, nontender submandibular lymph node that has been present for six weeks. What is the next step?

  1. Warm compresses and analgesics
  2. Prescribe antibiotics and recheck in three months
  3. Observe for six months
  4. Refer for evaluation of possible malignancy Correct answer.

Explanation

A persistent, firm, fixed, and nontender node in an older adult is a classic presentation of possible metastatic disease or lymphoma and requires prompt referral. Reactive nodes are typically tender and mobile and resolve within a few weeks.

Question 22Diagnosis and Treatment Planning

Which radiograph is most appropriate for detecting interproximal caries in an adult with intact contacts?

  1. Bitewing radiographs Correct answer.
  2. Lateral cephalometric radiograph
  3. Occlusal radiograph
  4. Panoramic radiograph

Explanation

Bitewing images project the crowns of maxillary and mandibular posterior teeth without overlap, making them the most sensitive intraoral technique for interproximal caries. Panoramic and cephalometric images lack the resolution needed for this purpose.

Question 23Diagnosis and Treatment Planning

A patient who received intravenous zoledronic acid for multiple myeloma two years ago needs a nonrestorable mandibular molar extracted. What is the most appropriate approach?

  1. Conservative therapy such as endodontics or coronectomy Correct answer.
  2. Order a serum CTX and extract if below 150 pg/mL
  3. Proceed with extraction and place a long-term antibiotic
  4. Refuse all dental treatment

Explanation

In patients with prior intravenous bisphosphonate exposure, atraumatic and conservative alternatives such as endodontic treatment or coronectomy reduce the risk of medication-related osteonecrosis of the jaw. Risk counseling and informed consent are essential when extraction is unavoidable.

Question 24Diagnosis and Treatment Planning

A patient with poorly controlled diabetes (HbA1c 9.5%) has generalized severe periodontitis. Which approach is most appropriate?

  1. Postpone all periodontal care until HbA1c is normal
  2. Extract all periodontally involved teeth
  3. Proceed with nonsurgical periodontal therapy Correct answer.
  4. Rely on systemic antibiotics alone

Explanation

Nonsurgical periodontal therapy is indicated and can modestly improve glycemic control, so care should not be withheld while awaiting perfect control. Coordination with the physician and avoidance of elective surgery during poor control are appropriate precautions.

Question 25Diagnosis and Treatment Planning

A patient taking several antihypertensives and an antidepressant reports persistent dry mouth. What is the most appropriate initial management?

  1. Discontinue all medications
  2. Saliva substitutes and caries prevention Correct answer.
  3. Immediate sialography
  4. Bilateral parotid biopsy

Explanation

Medication-induced xerostomia is managed symptomatically with saliva substitutes, hydration, sugar-free sialogogues, and intensified fluoride and caries prevention. Medication changes are considered only in consultation with the prescribing clinician.

Question 26Diagnosis and Treatment Planning

How should a patient's chief complaint be recorded in the dental record?

  1. As the dentist's primary diagnosis
  2. As the proposed treatment plan
  3. As a standardized diagnostic code
  4. In the patient's own words Correct answer.

Explanation

The chief complaint is documented verbatim so the record reflects the patient's priority and perspective. It anchors the history of present illness and is later reconciled with clinical findings.

Question 27Diagnosis and Treatment Planning

A patient with well-controlled asthma and no limitation of daily activity is assigned which ASA physical status?

  1. ASA III
  2. ASA II Correct answer.
  3. ASA I
  4. ASA IV

Explanation

ASA II describes a patient with mild systemic disease and no functional limitation, which fits well-controlled asthma. ASA I requires the absence of any systemic disease.

Question 28Diagnosis and Treatment Planning

A tooth with a deep carious lesion gives sharp pain to cold that stops within seconds after the stimulus is removed. Which pulpal diagnosis fits best?

  1. Normal pulp
  2. Reversible pulpitis Correct answer.
  3. Symptomatic irreversible pulpitis
  4. Pulpal necrosis

Explanation

Provoked pain that resolves promptly once the stimulus is withdrawn is characteristic of reversible pulpitis. Irreversible pulpitis produces lingering pain, and a necrotic pulp does not respond.

Question 29Diagnosis and Treatment Planning

Which radiographic examination is the most appropriate initial survey for a completely edentulous patient?

  1. Panoramic radiograph Correct answer.
  2. Bitewing radiographs
  3. Full-mouth periapical series
  4. Occlusal radiographs

Explanation

A panoramic radiograph images the entire maxilla and mandible in one exposure, showing retained roots, impacted teeth, sinuses, and the temporomandibular joints. Intraoral surveys are limited in scope.

Question 30Diagnosis and Treatment Planning

What is the most appropriate first step when evaluating a new patient with multiple dental problems?

  1. Extracting the most painful tooth
  2. Ordering a cone beam CT scan
  3. Obtaining a complete medical and dental history Correct answer.
  4. Referring to a specialist immediately

Explanation

A comprehensive history and examination establish the diagnoses, risk factors, and priorities that guide all later decisions. Treatment and imaging are selected after this assessment.

Question 31Diagnosis and Treatment Planning

What is the primary purpose of a problem list in a treatment plan?

  1. To record the fees for each procedure
  2. To list all materials used during treatment
  3. To list diagnoses in order of care priority Correct answer.
  4. To document the patient's insurance coverage and benefits

Explanation

The problem list summarizes the patient's diagnoses and needs, ordered by urgency, so that care can be sequenced logically. It is a clinical rather than an administrative document.

Question 32Diagnosis and Treatment Planning

Which history finding is most important to identify before prescribing an NSAID for dental pain?

  1. Seasonal allergic rhinitis
  2. Childhood asthma
  3. Peptic ulcer disease Correct answer.
  4. Hypothyroidism

Explanation

NSAIDs inhibit prostaglandin synthesis and can cause gastric mucosal injury and bleeding, so a history of peptic ulcer disease is a relative contraindication. Most of the other conditions listed do not preclude short-term NSAID use.

Question 33Diagnosis and Treatment Planning

What is a differential diagnosis?

  1. The diagnosis most likely to be correct
  2. A list of treatments ranked by success
  3. A ranked list of possible diagnoses Correct answer.
  4. The final confirmed diagnosis after biopsy

Explanation

A differential diagnosis is an ordered list of conditions that could explain the findings and is refined as test results return. It is not the final diagnosis until confirmation.

Question 34Diagnosis and Treatment Planning

A mandibular molar is tender to percussion, does not respond to cold, and shows a widened periodontal ligament space. Which diagnosis is most likely?

  1. Reversible pulpitis with normal apical tissues
  2. Normal pulp with acute apical abscess
  3. Irreversible pulpitis with asymptomatic apical periodontitis
  4. Necrotic pulp with symptomatic apical periodontitis Correct answer.

Explanation

Absent cold response indicates a necrotic pulp, while percussion tenderness and a widened periodontal ligament space indicate symptomatic apical periodontitis. An acute abscess would typically present with swelling or purulent drainage.

Question 35Diagnosis and Treatment Planning

Which method definitively distinguishes a periapical cyst from a periapical granuloma?

  1. Histopathologic examination Correct answer.
  2. Periapical radiograph
  3. Percussion testing
  4. Cold vitality testing

Explanation

Both lesions arise from a necrotic pulp and appear identical clinically and radiographically. Only microscopic identification of an epithelium-lined cavity confirms a cyst.

Question 36Diagnosis and Treatment Planning

A patient has clicking, pain, and limited opening of the temporomandibular joint. Which imaging study best evaluates disk position?

  1. Magnetic resonance imaging Correct answer.
  2. Bitewing radiograph
  3. Cone beam computed tomography
  4. Panoramic radiograph

Explanation

MRI provides direct visualization of the articular disk, its position, and surrounding soft tissues. CBCT and plain films show only osseous structures.

Question 37Diagnosis and Treatment Planning

A patient with a documented penicillin allergy needs antibiotic prophylaxis before an extraction. Which regimen is recommended?

  1. Cephalexin 2 g orally Correct answer.
  2. Amoxicillin 2 g orally
  3. Clindamycin 600 mg orally
  4. Penicillin V 2 g orally

Explanation

Current American Heart Association guidance lists cephalexin 2 g, azithromycin 500 mg, or doxycycline 100 mg for patients with penicillin allergy. Clindamycin is no longer recommended because of Clostridioides difficile risk.

Question 38Diagnosis and Treatment Planning

Which finding separates Stage III from Stage II periodontitis?

  1. Interdental attachment loss of 5 mm or more Correct answer.
  2. Presence of supragingival calculus
  3. Bone loss confined to the cervical third
  4. Bleeding on probing at 30% of sites

Explanation

Staging is based on severity and complexity; Stage III requires interdental clinical attachment loss of 5 mm or more, tooth loss from periodontitis, or complex defects. Stage II is limited to 3 to 4 mm of attachment loss.

Question 39Diagnosis and Treatment Planning

A patient attending for a routine cleaning has a blood pressure of 168/102 mmHg and no symptoms. What is the most appropriate action?

  1. Extract all teeth at this visit
  2. Proceed with treatment and recheck in one year
  3. Defer care and refer for medical evaluation Correct answer.
  4. Administer an antihypertensive and proceed

Explanation

Markedly elevated pressure of 160/100 mmHg or higher warrants deferral of elective care and referral for medical assessment. This level corresponds to stage 2 hypertension.

Question 40Diagnosis and Treatment Planning

During a restorative appointment, a patient reports crushing substernal chest pain and shortness of breath. What is the most appropriate immediate action?

  1. Stop, call emergency services, give oxygen Correct answer.
  2. Give oral penicillin and document the event
  3. Continue treatment and re-evaluate in 15 minutes
  4. Place the patient supine and give a local anesthetic

Explanation

These symptoms suggest acute myocardial infarction, which requires stopping treatment, activating emergency services, administering oxygen, and monitoring vital signs. Prompt transfer is essential.

Question 41Diagnosis and Treatment Planning

Which statement best describes the positive predictive value of a diagnostic test?

  1. The proportion of healthy patients who test negative
  2. The ability of a test to detect disease when present
  3. Probability that a positive result means disease Correct answer.
  4. The proportion of diseased patients who test positive

Explanation

Positive predictive value is the probability that a patient with a positive test truly has the disease, and it depends on disease prevalence in the tested population. Sensitivity and specificity are intrinsic test properties.

Question 42Diagnosis and Treatment Planning

A patient has mild temporomandibular joint pain and clicking with no limitation of opening. What is the most appropriate initial management?

  1. Soft diet, NSAIDs, and jaw rest Correct answer.
  2. Permanent occlusal splint therapy for five years
  3. Bilateral joint replacement
  4. Immediate arthrocentesis under general anesthesia

Explanation

Initial management of temporomandibular disorders is conservative and reversible: soft diet, NSAIDs, jaw rest, and physical therapy. Irreversible or surgical options are reserved for refractory cases.

Question 43Diagnosis and Treatment Planning

Which factor is most critical when planning an implant in the posterior maxilla?

  1. Available bone height and sinus proximity Correct answer.
  2. The color of the adjacent teeth
  3. The patient's preferred implant brand
  4. The presence of a labial frenum

Explanation

Alveolar resorption and maxillary sinus pneumatization often leave insufficient bone height, so sinus proximity determines whether grafting is needed. This is the key anatomic constraint.

Question 44Diagnosis and Treatment Planning

A patient has generalized moderate periodontitis and several carious teeth but no pain. What is the most appropriate sequencing of care?

  1. Restore all carious teeth first, then treat periodontal disease
  2. Periodontal therapy and caries control, then restoration Correct answer.
  3. Full-mouth extractions followed by immediate dentures
  4. Place implants first, then address periodontal disease

Explanation

Active disease control, including periodontal therapy and caries stabilization, precedes definitive restorative work. Restoring teeth while inflammation and caries remain active risks failure.

Question 45Diagnosis and Treatment Planning

A patient with a persistent oral ulcer declines the recommended biopsy. What is the most appropriate action?

  1. Document refusal and schedule follow-up monitoring Correct answer.
  2. Discharge the patient from the practice permanently
  3. Tell the patient the lesion is definitely benign and stop worrying
  4. Perform the biopsy without consent

Explanation

A competent patient has the right to refuse any treatment; the clinician must document the discussion of risks and alternatives and arrange follow-up. Acting without consent constitutes battery.

Question 46Diagnosis and Treatment Planning

A patient has dry eyes, dry mouth, and bilateral parotid enlargement. Which test is most useful in confirming Sjögren syndrome?

  1. Labial salivary gland biopsy Correct answer.
  2. Salivary cortisol measurement
  3. Sialography with contrast
  4. Panoramic radiograph

Explanation

A labial minor salivary gland biopsy showing focal lymphocytic sialadenitis, together with anti-SSA/Ro antibodies, supports the diagnosis of Sjögren syndrome. Imaging and cortisol testing are not confirmatory.

Question 47Diagnosis and Treatment Planning

A bluish, pulsatile swelling of the mandible yields bright red blood that refills the syringe on aspiration. What is the most appropriate next step?

  1. Aspirate again to confirm the finding
  2. Perform an incisional biopsy immediately
  3. Prescribe antibiotics and recheck in a month
  4. Stop and refer for imaging Correct answer.

Explanation

Aspiration of nonclotting blood suggests a vascular lesion, and biopsy could cause severe hemorrhage. Imaging such as CT, MRI, or angiography and specialist referral are indicated.

Question 48Diagnosis and Treatment Planning

A patient received 60 Gy of external beam radiation to the mandible four years ago and now needs a nonrestorable molar extracted. What is the most appropriate management?

  1. Extraction without any modification of technique
  2. Refusal of all dental treatment indefinitely
  3. Extraction with immediate implant placement
  4. Oncology consult, atraumatic extraction, primary closure Correct answer.

Explanation

Irradiated bone has permanently impaired healing and remodeling, so osteoradionecrosis risk persists for life. Atraumatic extraction with primary closure, after oncology consultation and with consideration of hyperbaric oxygen, minimizes this risk.

Question 49Diagnosis and Treatment Planning

A scalloped radiolucency at the mandibular angle yields thick, cheesy keratinous material on aspiration. Which diagnosis is most likely?

  1. Odontogenic keratocyst Correct answer.
  2. Ameloblastoma
  3. Radicular cyst
  4. Dentigerous cyst

Explanation

The odontogenic keratocyst characteristically produces a cheesy keratinaceous aspirate and grows with a scalloped, locally aggressive pattern. This aspirate finding helps distinguish it from other jaw cysts.

Question 50Diagnosis and Treatment Planning

A postmenopausal woman reports burning of the tongue and lips for six months, with no visible lesions and normal taste. What is the most appropriate initial approach?

  1. Reassure that symptoms are psychological
  2. Start empirical antifungal therapy
  3. Perform an immediate tongue biopsy
  4. Exclude local and systemic causes first Correct answer.

Explanation

Burning mouth syndrome is a diagnosis of exclusion, so candidiasis, anemia, vitamin deficiencies, diabetes, xerostomia, and medication effects must be ruled out first. Biopsy is not indicated in the absence of a visible lesion.