Dental Hygiene OSCE Test Bank 2026/2027
Dental Hygiene OSCE Exam Test Bank – 2026/2027
Objective Structured Clinical Examination | Complete Q&A & Verified Solutions
100 Scenario-Based Questions | Expert-Aligned | OSCE Format
This comprehensive Dental Hygiene OSCE (Objective Structured Clinical Examination) Test Bank is designed for
dental hygiene students and professionals preparing for clinical competency examinations. It contains 100 scenario-
based multiple-choice questions covering all major domains of dental hygiene practice, including patient
assessment, clinical examination, periodontal assessment, radiographic interpretation, treatment planning,
preventive dentistry, local anesthesia, non-surgical periodontal therapy, nutritional counseling, ethics and
professionalism, and medical emergencies. Each question features a clinical scenario that tests critical thinking and
clinical decision-making skills, followed by the correct answer and a detailed evidence-based rationale aligned with
current standards of care.
Section I: Patient Assessment & Medical History Review
1. A 62-year-old male patient presents for a dental hygiene appointment. His medical history reveals he has been
taking warfarin (Coumadin) for atrial fibrillation for the past 5 years. His current INR is 2.8. Which of the
following is the MOST appropriate action before proceeding with scaling and root planing?
A. Proceed with treatment as the INR is within the B. Consult the patient's physician before any scaling
therapeutic range procedures
C. Defer all treatment until the INR drops below 1.5 D. Prescribe prophylactic antibiotics before treatment
Answer: A. Proceed with treatment as the INR is within the therapeutic range
Rationale: The therapeutic range for warfarin in atrial fibrillation is an INR of 2.0–3.0. An INR of 2.8 is within this range, and
current guidelines support performing scaling and root planing without physician consultation when INR is ≤3.5, provided
atraumatic techniques are used and post-operative hemorrhage control measures are available.
2. A 45-year-old female patient with a prosthetic heart valve (mechanical) is scheduled for a prophylaxis
appointment. She asks whether she needs antibiotic prophylaxis. According to current AHA guidelines, which of
the following is correct?
A. Antibiotic prophylaxis is required for all dental procedures
B. Antibiotic prophylaxis is recommended only for procedures involving manipulation of gingival tissue
C. Antibiotic prophylaxis is not recommended for this patient
D. Antibiotic prophylaxis is needed only if the patient has a history of infective endocarditis
Answer: B. Antibiotic prophylaxis is recommended only for procedures involving manipulation of gingival
tissue
Rationale: Current AHA guidelines (2007, reaffirmed 2017) recommend antibiotic prophylaxis only for patients with
prosthetic cardiac valves, previous infective endocarditis, congenital heart disease (certain types), and cardiac transplant
recipients with valvulopathy. Prophylaxis is indicated for dental procedures involving manipulation of gingival tissue, the
periapical region, or perforation of oral mucosa.
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, Dental Hygiene OSCE Test Bank 2026/2027
3. A 28-year-old patient who is 14 weeks pregnant presents with generalized gingivitis and localized periodontal
pockets of 4 mm. Her obstetrician has classified her pregnancy as uncomplicated. Which of the following
represents the MOST appropriate management?
A. Defer all dental treatment until after delivery B. Perform supragingival debridement only; avoid
subgingival instrumentation
C. Provide scaling and root planing with local anesthesia D. Provide comprehensive periodontal treatment
without vasoconstrictor including subgingival debridement
Answer: D. Provide comprehensive periodontal treatment including subgingival debridement
Rationale: Current evidence supports that periodontal treatment during pregnancy is safe and beneficial. The second trimester
(weeks 14–28) is considered the safest period for dental treatment. Scaling and root planing with local anesthesia (including
those with vasoconstrictor) is appropriate. Deferring treatment may allow periodontal disease to worsen, which has been
associated with adverse pregnancy outcomes.
4. A dental hygienist records a patient's blood pressure as 162/98 mmHg. The patient has no history of
hypertension and reports no symptoms. According to the ACC/AHA blood pressure classification, how should
this reading be categorized?
A. Elevated blood pressure B. Stage 1 hypertension C. Stage 2 hypertension D. Hypertensive crisis
Answer: C. Stage 2 hypertension
Rationale: Per the 2017 ACC/AHA guidelines, blood pressure is classified as: Normal (<120/80), Elevated (120-129/<80),
Stage 1 HTN (130-139/80-89), Stage 2 HTN (≥140/≥90), and Hypertensive Crisis (>180/>120). A reading of 162/98 falls in
Stage 2 hypertension. Routine dental treatment should be deferred and medical referral is recommended.
5. A 55-year-old patient with type 2 diabetes mellitus (HbA1c 7.8%) presents for periodontal therapy. The dental
hygienist notes generalized moderate chronic periodontitis with probing depths of 5–6 mm and bleeding on
probing at 60% of sites. Which of the following is the MOST important consideration for this appointment?
A. Schedule appointments in the morning when blood glucose is typically lowest
B. Avoid local anesthetics with epinephrine
C. Provide treatment and emphasize the bidirectional relationship between diabetes and periodontal disease
D. Defer treatment until HbA1c is below 6.5%
Answer: C. Provide treatment and emphasize the bidirectional relationship between diabetes and
periodontal disease
Rationale: There is a well-established bidirectional relationship between diabetes and periodontal disease. Diabetes increases
the risk and severity of periodontitis, and periodontal inflammation negatively affects glycemic control. Treatment should
proceed with appropriate precautions. Appointments should ideally be scheduled after meals to reduce hypoglycemia risk, not
specifically in the morning.
6. A 70-year-old patient reports taking alendronate (Fosamax), a bisphosphonate, for the past 8 years for
osteoporosis. She is concerned about risks associated with dental treatment. Which of the following is the MOST
accurate statement?
A. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) risk is the same for oral and IV bisphosphonates
B. Oral bisphosphonate therapy of long duration (>4 years) is associated with a low but nonzero risk of BRONJ
C. All patients on oral bisphosphonates must have a drug holiday before any dental treatment
D. Bisphosphonates do not affect bone healing in the oral cavity
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, Dental Hygiene OSCE Test Bank 2026/2027
Answer: B. Oral bisphosphonate therapy of long duration (>4 years) is associated with a low but nonzero
risk of BRONJ
Rationale: While the risk of BRONJ is significantly higher with IV bisphosphonates (used in cancer treatment), long-term oral
bisphosphonate use (>4 years) carries a low but documented risk (approximately 0.01–0.04%). The American Dental
Association recommends not discontinuing oral bisphosphonates for routine dental treatment but advises careful assessment
before invasive procedures, maintaining good oral hygiene, and avoiding elective extractions when possible.
7. A dental hygienist is reviewing a new patient's medication list and notes the patient takes cyclosporine
following a kidney transplant. Which of the following oral conditions is this patient MOST likely to exhibit?
A. Geographic tongue B. Gingival overgrowth C. Oral lichen planus D. Median rhomboid
(hyperplasia) glossitis
Answer: B. Gingival overgrowth (hyperplasia)
Rationale: Cyclosporine, an immunosuppressant used in organ transplant recipients, is well known for causing gingival
overgrowth (gingival hyperplasia). This occurs in approximately 25–30% of patients and is more pronounced with poor oral
hygiene and concurrent use of calcium channel blockers. Management includes meticulous plaque control and possible
surgical reduction.
8. A 35-year-old HIV-positive patient with a CD4 count of 450 cells/μL and an undetectable viral load presents
for a routine dental hygiene appointment. Standard precautions are in place. Which ASA Physical Status
Classification is MOST appropriate for this patient?
A. ASA I B. ASA II C. ASA III D. ASA IV
Answer: C. ASA III
Rationale: ASA III is assigned to patients with severe systemic disease that limits activity but is not incapacitating. An HIV-
positive patient with a CD4 count of 450 (not severely immunocompromised) and controlled viral load has systemic disease
but is functional. ASA I is a healthy patient; ASA II is mild systemic disease; ASA IV is incapacitating disease that is a
constant threat to life.
9. A patient reports taking methotrexate for rheumatoid arthritis. Before scheduling subgingival instrumentation,
the dental hygienist should verify which of the following laboratory values?
A. Serum creatinine and complete blood count (CBC) B. Prothrombin time (PT/INR) only
C. Serum calcium and vitamin D levels D. Liver function tests only
Answer: A. Serum creatinine and complete blood count (CBC)
Rationale: Methotrexate is an immunosuppressive antimetabolite that can cause bone marrow suppression (leading to
leukopenia, thrombocytopenia, and anemia) and renal toxicity. Before invasive dental procedures, it is essential to verify both
the CBC (to ensure adequate platelet count and white blood cell count to prevent excessive bleeding and infection risk) and
serum creatinine (to assess renal function, as methotrexate is renally excreted).
10. A 50-year-old male patient reports episodes of chest pain brought on by exertion and relieved by rest. He takes
nitroglycerin sublingually as needed. During the dental appointment, he complains of chest discomfort that is not
relieved by his nitroglycerin. What is the MOST appropriate immediate action?
A. Administer a second dose of nitroglycerin and B. Activate emergency medical services (EMS)
continue monitoring immediately
C. Position the patient supine and administer oxygen D. Apply cold compresses to the patient's chest
Answer: B. Activate emergency medical services (EMS) immediately
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, Dental Hygiene OSCE Test Bank 2026/2027
Rationale: Chest pain not relieved by nitroglycerin after one dose may indicate a myocardial infarction rather than stable
angina. The standard protocol is to discontinue treatment, position the patient comfortably, activate EMS immediately, and
monitor vital signs while waiting. A second dose of nitroglycerin may be considered per the patient's physician instructions if
the first dose was ineffective, but EMS should not be delayed.
Section II: Extraoral & Intraoral Examination
11. During extraoral examination, a dental hygienist palpates a firm, non-tender, mobile submandibular lymph
node measuring approximately 1 cm in diameter on the right side. The patient has no other symptoms. Which of
the following is the MOST appropriate interpretation?
A. This is a normal finding; lymph nodes up to 1 cm are B. This indicates definite malignancy and requires
commonly palpable immediate biopsy
C. This is a sign of acute bacterial infection requiring D. This suggests a chronic viral infection such as HIV
antibiotic therapy
Answer: A. This is a normal finding; lymph nodes up to 1 cm are commonly palpable
Rationale: Lymph nodes up to 1 cm in diameter are commonly palpable in healthy individuals, particularly in the
submandibular and cervical regions. Normal lymph nodes are non-tender, mobile, and firm but not hard. Malignant nodes are
typically hard, fixed, and non-tender. Acute infection produces tender, enlarged nodes. Isolated palpable nodes without other
symptoms are generally considered a normal variation.
12. A patient reports clicking in the right TMJ when opening wide, accompanied by intermittent locking.
Maximum interincisal opening is 38 mm. On auscultation, a reciprocal click is noted (click on opening and
closing). Which of the following BEST describes this condition?
A. Acute closed lock of the TMJ B. Internal derangement with reducing disc
displacement (Wilkes Stage II)
C. Advanced osteoarthritis of the TMJ D. Myofascial pain dysfunction syndrome
Answer: B. Internal derangement with reducing disc displacement (Wilkes Stage II)
Rationale: A reciprocal click (click during both opening and closing) is the hallmark of disc displacement with reduction,
classified as Wilkes Stage II internal derangement. During opening, the condyle moves past the posterior band of the
displaced disc causing the click, and during closing, the disc relocates anteriorly causing a second click. Acute closed lock
(Wilkes Stage III) presents with limited opening and no reduction click.
13. During an intraoral soft tissue examination, a dental hygienist observes a well-defined, 8-mm white plaque on
the right lateral border of the tongue that cannot be wiped off. The patient, a 58-year-old smoker, reports it has
been present for 3 months. Which of the following is the MOST appropriate next step?
A. Reassure the patient and re-evaluate at the next 6- B. Advise the patient to stop smoking and apply topical
month recall steroid
C. Refer for biopsy to rule out dysplasia or carcinoma D. Prescribe antifungal medication and re-evaluate in 2
weeks
Answer: C. Refer for biopsy to rule out dysplasia or carcinoma
Rationale: A persistent (≥2 weeks), non-homogeneous white plaque on the lateral tongue border in a patient with tobacco use
is a red flag for oral potentially malignant disorders, including leukoplakia with dysplasia or squamous cell carcinoma. The
4
Dental Hygiene OSCE Exam Test Bank – 2026/2027
Objective Structured Clinical Examination | Complete Q&A & Verified Solutions
100 Scenario-Based Questions | Expert-Aligned | OSCE Format
This comprehensive Dental Hygiene OSCE (Objective Structured Clinical Examination) Test Bank is designed for
dental hygiene students and professionals preparing for clinical competency examinations. It contains 100 scenario-
based multiple-choice questions covering all major domains of dental hygiene practice, including patient
assessment, clinical examination, periodontal assessment, radiographic interpretation, treatment planning,
preventive dentistry, local anesthesia, non-surgical periodontal therapy, nutritional counseling, ethics and
professionalism, and medical emergencies. Each question features a clinical scenario that tests critical thinking and
clinical decision-making skills, followed by the correct answer and a detailed evidence-based rationale aligned with
current standards of care.
Section I: Patient Assessment & Medical History Review
1. A 62-year-old male patient presents for a dental hygiene appointment. His medical history reveals he has been
taking warfarin (Coumadin) for atrial fibrillation for the past 5 years. His current INR is 2.8. Which of the
following is the MOST appropriate action before proceeding with scaling and root planing?
A. Proceed with treatment as the INR is within the B. Consult the patient's physician before any scaling
therapeutic range procedures
C. Defer all treatment until the INR drops below 1.5 D. Prescribe prophylactic antibiotics before treatment
Answer: A. Proceed with treatment as the INR is within the therapeutic range
Rationale: The therapeutic range for warfarin in atrial fibrillation is an INR of 2.0–3.0. An INR of 2.8 is within this range, and
current guidelines support performing scaling and root planing without physician consultation when INR is ≤3.5, provided
atraumatic techniques are used and post-operative hemorrhage control measures are available.
2. A 45-year-old female patient with a prosthetic heart valve (mechanical) is scheduled for a prophylaxis
appointment. She asks whether she needs antibiotic prophylaxis. According to current AHA guidelines, which of
the following is correct?
A. Antibiotic prophylaxis is required for all dental procedures
B. Antibiotic prophylaxis is recommended only for procedures involving manipulation of gingival tissue
C. Antibiotic prophylaxis is not recommended for this patient
D. Antibiotic prophylaxis is needed only if the patient has a history of infective endocarditis
Answer: B. Antibiotic prophylaxis is recommended only for procedures involving manipulation of gingival
tissue
Rationale: Current AHA guidelines (2007, reaffirmed 2017) recommend antibiotic prophylaxis only for patients with
prosthetic cardiac valves, previous infective endocarditis, congenital heart disease (certain types), and cardiac transplant
recipients with valvulopathy. Prophylaxis is indicated for dental procedures involving manipulation of gingival tissue, the
periapical region, or perforation of oral mucosa.
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, Dental Hygiene OSCE Test Bank 2026/2027
3. A 28-year-old patient who is 14 weeks pregnant presents with generalized gingivitis and localized periodontal
pockets of 4 mm. Her obstetrician has classified her pregnancy as uncomplicated. Which of the following
represents the MOST appropriate management?
A. Defer all dental treatment until after delivery B. Perform supragingival debridement only; avoid
subgingival instrumentation
C. Provide scaling and root planing with local anesthesia D. Provide comprehensive periodontal treatment
without vasoconstrictor including subgingival debridement
Answer: D. Provide comprehensive periodontal treatment including subgingival debridement
Rationale: Current evidence supports that periodontal treatment during pregnancy is safe and beneficial. The second trimester
(weeks 14–28) is considered the safest period for dental treatment. Scaling and root planing with local anesthesia (including
those with vasoconstrictor) is appropriate. Deferring treatment may allow periodontal disease to worsen, which has been
associated with adverse pregnancy outcomes.
4. A dental hygienist records a patient's blood pressure as 162/98 mmHg. The patient has no history of
hypertension and reports no symptoms. According to the ACC/AHA blood pressure classification, how should
this reading be categorized?
A. Elevated blood pressure B. Stage 1 hypertension C. Stage 2 hypertension D. Hypertensive crisis
Answer: C. Stage 2 hypertension
Rationale: Per the 2017 ACC/AHA guidelines, blood pressure is classified as: Normal (<120/80), Elevated (120-129/<80),
Stage 1 HTN (130-139/80-89), Stage 2 HTN (≥140/≥90), and Hypertensive Crisis (>180/>120). A reading of 162/98 falls in
Stage 2 hypertension. Routine dental treatment should be deferred and medical referral is recommended.
5. A 55-year-old patient with type 2 diabetes mellitus (HbA1c 7.8%) presents for periodontal therapy. The dental
hygienist notes generalized moderate chronic periodontitis with probing depths of 5–6 mm and bleeding on
probing at 60% of sites. Which of the following is the MOST important consideration for this appointment?
A. Schedule appointments in the morning when blood glucose is typically lowest
B. Avoid local anesthetics with epinephrine
C. Provide treatment and emphasize the bidirectional relationship between diabetes and periodontal disease
D. Defer treatment until HbA1c is below 6.5%
Answer: C. Provide treatment and emphasize the bidirectional relationship between diabetes and
periodontal disease
Rationale: There is a well-established bidirectional relationship between diabetes and periodontal disease. Diabetes increases
the risk and severity of periodontitis, and periodontal inflammation negatively affects glycemic control. Treatment should
proceed with appropriate precautions. Appointments should ideally be scheduled after meals to reduce hypoglycemia risk, not
specifically in the morning.
6. A 70-year-old patient reports taking alendronate (Fosamax), a bisphosphonate, for the past 8 years for
osteoporosis. She is concerned about risks associated with dental treatment. Which of the following is the MOST
accurate statement?
A. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) risk is the same for oral and IV bisphosphonates
B. Oral bisphosphonate therapy of long duration (>4 years) is associated with a low but nonzero risk of BRONJ
C. All patients on oral bisphosphonates must have a drug holiday before any dental treatment
D. Bisphosphonates do not affect bone healing in the oral cavity
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, Dental Hygiene OSCE Test Bank 2026/2027
Answer: B. Oral bisphosphonate therapy of long duration (>4 years) is associated with a low but nonzero
risk of BRONJ
Rationale: While the risk of BRONJ is significantly higher with IV bisphosphonates (used in cancer treatment), long-term oral
bisphosphonate use (>4 years) carries a low but documented risk (approximately 0.01–0.04%). The American Dental
Association recommends not discontinuing oral bisphosphonates for routine dental treatment but advises careful assessment
before invasive procedures, maintaining good oral hygiene, and avoiding elective extractions when possible.
7. A dental hygienist is reviewing a new patient's medication list and notes the patient takes cyclosporine
following a kidney transplant. Which of the following oral conditions is this patient MOST likely to exhibit?
A. Geographic tongue B. Gingival overgrowth C. Oral lichen planus D. Median rhomboid
(hyperplasia) glossitis
Answer: B. Gingival overgrowth (hyperplasia)
Rationale: Cyclosporine, an immunosuppressant used in organ transplant recipients, is well known for causing gingival
overgrowth (gingival hyperplasia). This occurs in approximately 25–30% of patients and is more pronounced with poor oral
hygiene and concurrent use of calcium channel blockers. Management includes meticulous plaque control and possible
surgical reduction.
8. A 35-year-old HIV-positive patient with a CD4 count of 450 cells/μL and an undetectable viral load presents
for a routine dental hygiene appointment. Standard precautions are in place. Which ASA Physical Status
Classification is MOST appropriate for this patient?
A. ASA I B. ASA II C. ASA III D. ASA IV
Answer: C. ASA III
Rationale: ASA III is assigned to patients with severe systemic disease that limits activity but is not incapacitating. An HIV-
positive patient with a CD4 count of 450 (not severely immunocompromised) and controlled viral load has systemic disease
but is functional. ASA I is a healthy patient; ASA II is mild systemic disease; ASA IV is incapacitating disease that is a
constant threat to life.
9. A patient reports taking methotrexate for rheumatoid arthritis. Before scheduling subgingival instrumentation,
the dental hygienist should verify which of the following laboratory values?
A. Serum creatinine and complete blood count (CBC) B. Prothrombin time (PT/INR) only
C. Serum calcium and vitamin D levels D. Liver function tests only
Answer: A. Serum creatinine and complete blood count (CBC)
Rationale: Methotrexate is an immunosuppressive antimetabolite that can cause bone marrow suppression (leading to
leukopenia, thrombocytopenia, and anemia) and renal toxicity. Before invasive dental procedures, it is essential to verify both
the CBC (to ensure adequate platelet count and white blood cell count to prevent excessive bleeding and infection risk) and
serum creatinine (to assess renal function, as methotrexate is renally excreted).
10. A 50-year-old male patient reports episodes of chest pain brought on by exertion and relieved by rest. He takes
nitroglycerin sublingually as needed. During the dental appointment, he complains of chest discomfort that is not
relieved by his nitroglycerin. What is the MOST appropriate immediate action?
A. Administer a second dose of nitroglycerin and B. Activate emergency medical services (EMS)
continue monitoring immediately
C. Position the patient supine and administer oxygen D. Apply cold compresses to the patient's chest
Answer: B. Activate emergency medical services (EMS) immediately
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, Dental Hygiene OSCE Test Bank 2026/2027
Rationale: Chest pain not relieved by nitroglycerin after one dose may indicate a myocardial infarction rather than stable
angina. The standard protocol is to discontinue treatment, position the patient comfortably, activate EMS immediately, and
monitor vital signs while waiting. A second dose of nitroglycerin may be considered per the patient's physician instructions if
the first dose was ineffective, but EMS should not be delayed.
Section II: Extraoral & Intraoral Examination
11. During extraoral examination, a dental hygienist palpates a firm, non-tender, mobile submandibular lymph
node measuring approximately 1 cm in diameter on the right side. The patient has no other symptoms. Which of
the following is the MOST appropriate interpretation?
A. This is a normal finding; lymph nodes up to 1 cm are B. This indicates definite malignancy and requires
commonly palpable immediate biopsy
C. This is a sign of acute bacterial infection requiring D. This suggests a chronic viral infection such as HIV
antibiotic therapy
Answer: A. This is a normal finding; lymph nodes up to 1 cm are commonly palpable
Rationale: Lymph nodes up to 1 cm in diameter are commonly palpable in healthy individuals, particularly in the
submandibular and cervical regions. Normal lymph nodes are non-tender, mobile, and firm but not hard. Malignant nodes are
typically hard, fixed, and non-tender. Acute infection produces tender, enlarged nodes. Isolated palpable nodes without other
symptoms are generally considered a normal variation.
12. A patient reports clicking in the right TMJ when opening wide, accompanied by intermittent locking.
Maximum interincisal opening is 38 mm. On auscultation, a reciprocal click is noted (click on opening and
closing). Which of the following BEST describes this condition?
A. Acute closed lock of the TMJ B. Internal derangement with reducing disc
displacement (Wilkes Stage II)
C. Advanced osteoarthritis of the TMJ D. Myofascial pain dysfunction syndrome
Answer: B. Internal derangement with reducing disc displacement (Wilkes Stage II)
Rationale: A reciprocal click (click during both opening and closing) is the hallmark of disc displacement with reduction,
classified as Wilkes Stage II internal derangement. During opening, the condyle moves past the posterior band of the
displaced disc causing the click, and during closing, the disc relocates anteriorly causing a second click. Acute closed lock
(Wilkes Stage III) presents with limited opening and no reduction click.
13. During an intraoral soft tissue examination, a dental hygienist observes a well-defined, 8-mm white plaque on
the right lateral border of the tongue that cannot be wiped off. The patient, a 58-year-old smoker, reports it has
been present for 3 months. Which of the following is the MOST appropriate next step?
A. Reassure the patient and re-evaluate at the next 6- B. Advise the patient to stop smoking and apply topical
month recall steroid
C. Refer for biopsy to rule out dysplasia or carcinoma D. Prescribe antifungal medication and re-evaluate in 2
weeks
Answer: C. Refer for biopsy to rule out dysplasia or carcinoma
Rationale: A persistent (≥2 weeks), non-homogeneous white plaque on the lateral tongue border in a patient with tobacco use
is a red flag for oral potentially malignant disorders, including leukoplakia with dysplasia or squamous cell carcinoma. The
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