Pathology · single question

Patient presents with brown/black discoloration on dorsum of tongue (see image). What to do FIRST?

Image for the question
  1. Oral hygiene instruction
  2. Antifungal medication
  3. Incisional biopsy
  4. Immediate referral to oral medicine
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Correct answer: A. Oral hygiene instruction

Image shows BLACK HAIRY TONGUE (lingua villosa nigra) — elongated pigmented filiform papillae from poor oral hygiene, tobacco, antibiotics, coffee/tea. FIRST step: oral hygiene instruction and remove causative factor. Condition typically resolves. Biopsy NOT indicated.

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