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INBDE — Integrated National Board
Dental Examination Practice Exam 2026
| 100 Questions & Answers with
Detailed Rationales | Complete Exam
Prep & Study Guide
1. A patient presents with spontaneous, lingering pain to cold and severe
nocturnal pain. The tooth is not tender to percussion. Which pulpal diagnosis is
most appropriate?
A. Reversible pulpitis
B. Pulpal necrosis
C. Symptomatic irreversible pulpitis
D. Asymptomatic irreversible pulpitis
Answer: Symptomatic irreversible pulpitis
Rationale: Spontaneous pain and lingering thermal pain are classic features of
symptomatic irreversible pulpitis. The absence of percussion sensitivity suggests
that apical periodontal tissues may not yet be significantly involved.
,2. A mandibular first molar has a deep carious lesion approaching the pulp. The
tooth responds normally to cold, and there is no spontaneous pain. Which
treatment is most appropriate when caries removal would risk pulp exposure?
A. Immediate pulpectomy
B. Extraction
C. Selective caries removal with preservation of the affected dentin near the
pulp
D. Complete excavation until all dentin is hard
Answer: Selective caries removal with preservation of the affected dentin near
the pulp
Rationale: In a vital tooth with a deep lesion, selective caries removal reduces
the risk of pulp exposure while maintaining pulpal vitality. Modern minimally
invasive caries management favors preservation of tooth structure and pulp
health.
3. A patient has a painless, well-defined unilocular radiolucency associated with
the crown of an impacted mandibular third molar. The radiolucency attaches
near the cemento-enamel junction. Which lesion is most likely?
A. Odontogenic keratocyst
B. Ameloblastoma
C. Dentigerous cyst
D. Radicular cyst
Answer: Dentigerous cyst
Rationale: A dentigerous cyst characteristically surrounds the crown of an
unerupted tooth and attaches near the CEJ. It is one of the most common
developmental odontogenic cysts.
,4. A 35-year-old patient has a posterior mandibular radiolucency that extends
anteroposteriorly with relatively little buccolingual expansion. Which lesion
should be strongly considered?
A. Periapical granuloma
B. Odontogenic keratocyst
C. Traumatic bone cyst
D. Central giant cell granuloma
Answer: Odontogenic keratocyst
Rationale: Odontogenic keratocysts may grow extensively within cancellous
bone with limited cortical expansion. Their tendency for anteroposterior growth
and recurrence makes accurate diagnosis and follow-up important.
5. A patient taking warfarin requires a dental extraction. What is the most
appropriate initial approach?
A. Automatically discontinue warfarin for 7 days
B. Replace warfarin with aspirin
C. Assess anticoagulation status and coordinate management without
unnecessarily interrupting therapy
D. Perform the extraction only after INR reaches zero
Answer: Assess anticoagulation status and coordinate management without
unnecessarily interrupting therapy
Rationale: For many routine dental procedures, anticoagulation can be
continued with appropriate local hemostatic measures. Unnecessary
interruption may increase thromboembolic risk. The patient's current INR,
procedure, medical history, and physician guidance must be considered.
6. Which local anesthetic is generally preferred when prolonged soft-tissue
anesthesia is undesirable in a patient requiring a short dental procedure?
, A. Bupivacaine
B. Lidocaine
C. Etidocaine
D. Ropivacaine
Answer: Lidocaine
Rationale: Lidocaine has a well-established safety and efficacy profile and
provides an appropriate duration for many routine dental procedures. Long-
acting agents such as bupivacaine produce substantially longer anesthesia.
7. A patient develops pallor, diaphoresis, nausea, and transient loss of
consciousness immediately after receiving local anesthesia. The patient is
breathing normally. What is the most likely diagnosis?
A. Anaphylaxis
B. Hypoglycemia
C. Vasovagal syncope
D. Acute myocardial infarction
Answer: Vasovagal syncope
Rationale: Vasovagal syncope is commonly associated with anxiety, pain,
autonomic activation, pallor, sweating, nausea, and brief loss of consciousness.
Initial management includes positioning the patient appropriately and
maintaining the airway.
8. Which structure forms the primary barrier against bacterial penetration in the
periodontium?
A. Cementum
B. Alveolar bone
C. Junctional epithelium
D. Periodontal ligament fibers
INBDE — Integrated National Board
Dental Examination Practice Exam 2026
| 100 Questions & Answers with
Detailed Rationales | Complete Exam
Prep & Study Guide
1. A patient presents with spontaneous, lingering pain to cold and severe
nocturnal pain. The tooth is not tender to percussion. Which pulpal diagnosis is
most appropriate?
A. Reversible pulpitis
B. Pulpal necrosis
C. Symptomatic irreversible pulpitis
D. Asymptomatic irreversible pulpitis
Answer: Symptomatic irreversible pulpitis
Rationale: Spontaneous pain and lingering thermal pain are classic features of
symptomatic irreversible pulpitis. The absence of percussion sensitivity suggests
that apical periodontal tissues may not yet be significantly involved.
,2. A mandibular first molar has a deep carious lesion approaching the pulp. The
tooth responds normally to cold, and there is no spontaneous pain. Which
treatment is most appropriate when caries removal would risk pulp exposure?
A. Immediate pulpectomy
B. Extraction
C. Selective caries removal with preservation of the affected dentin near the
pulp
D. Complete excavation until all dentin is hard
Answer: Selective caries removal with preservation of the affected dentin near
the pulp
Rationale: In a vital tooth with a deep lesion, selective caries removal reduces
the risk of pulp exposure while maintaining pulpal vitality. Modern minimally
invasive caries management favors preservation of tooth structure and pulp
health.
3. A patient has a painless, well-defined unilocular radiolucency associated with
the crown of an impacted mandibular third molar. The radiolucency attaches
near the cemento-enamel junction. Which lesion is most likely?
A. Odontogenic keratocyst
B. Ameloblastoma
C. Dentigerous cyst
D. Radicular cyst
Answer: Dentigerous cyst
Rationale: A dentigerous cyst characteristically surrounds the crown of an
unerupted tooth and attaches near the CEJ. It is one of the most common
developmental odontogenic cysts.
,4. A 35-year-old patient has a posterior mandibular radiolucency that extends
anteroposteriorly with relatively little buccolingual expansion. Which lesion
should be strongly considered?
A. Periapical granuloma
B. Odontogenic keratocyst
C. Traumatic bone cyst
D. Central giant cell granuloma
Answer: Odontogenic keratocyst
Rationale: Odontogenic keratocysts may grow extensively within cancellous
bone with limited cortical expansion. Their tendency for anteroposterior growth
and recurrence makes accurate diagnosis and follow-up important.
5. A patient taking warfarin requires a dental extraction. What is the most
appropriate initial approach?
A. Automatically discontinue warfarin for 7 days
B. Replace warfarin with aspirin
C. Assess anticoagulation status and coordinate management without
unnecessarily interrupting therapy
D. Perform the extraction only after INR reaches zero
Answer: Assess anticoagulation status and coordinate management without
unnecessarily interrupting therapy
Rationale: For many routine dental procedures, anticoagulation can be
continued with appropriate local hemostatic measures. Unnecessary
interruption may increase thromboembolic risk. The patient's current INR,
procedure, medical history, and physician guidance must be considered.
6. Which local anesthetic is generally preferred when prolonged soft-tissue
anesthesia is undesirable in a patient requiring a short dental procedure?
, A. Bupivacaine
B. Lidocaine
C. Etidocaine
D. Ropivacaine
Answer: Lidocaine
Rationale: Lidocaine has a well-established safety and efficacy profile and
provides an appropriate duration for many routine dental procedures. Long-
acting agents such as bupivacaine produce substantially longer anesthesia.
7. A patient develops pallor, diaphoresis, nausea, and transient loss of
consciousness immediately after receiving local anesthesia. The patient is
breathing normally. What is the most likely diagnosis?
A. Anaphylaxis
B. Hypoglycemia
C. Vasovagal syncope
D. Acute myocardial infarction
Answer: Vasovagal syncope
Rationale: Vasovagal syncope is commonly associated with anxiety, pain,
autonomic activation, pallor, sweating, nausea, and brief loss of consciousness.
Initial management includes positioning the patient appropriately and
maintaining the airway.
8. Which structure forms the primary barrier against bacterial penetration in the
periodontium?
A. Cementum
B. Alveolar bone
C. Junctional epithelium
D. Periodontal ligament fibers
