Name: Dry Mouth 1
Creator: Abeer Aamir
Keywords: Ear Nose and Throat,Endocrine, OTC, Responding to symptoms

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By Abeer Aamir • July 07, 2026 • Last reviewed: 27/08/2026 •

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Summary Intermediate

In this scenario, the community pharmacist speaks to a 68-year-old man who presents with dry mouth. The student must take a history, consider the contribution of diabetes and its medications, and advise on appropriate over-the-counter management.

Please ensure that this scenario and mark scheme align with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.

You will need a student pharmacist and an actor for this scenario.

Revision Topics

Be aware, this may reveal any answers!

Student Instructions

Actor Instructions

This may reveal scenario objectives!

You are Gerald Hughes (Jeh-rald, Hyooz).

Opening statement: “Hello, I’ve been having a really dry mouth lately and it’s driving me mad - I was hoping you could help me.”

Patient information:

To be given if the student asks.

Name: Gerald Hughes
Age: 68
Past medical history:
- “I have type 2 diabetes, diagnosed about 12 years ago.”
- “I also have high blood pressure.”
Medication history:
- “I take metformin twice a day for my diabetes.”
- “I also take sitagliptin every morning"
- “I take amlodipine once a day for my blood pressure.”
- “I don’t take anything else, no herbal remedies or vitamins.”
Allergies:
- “Elastoplast - I get an itchy rash from it.”
Symptoms:
- “My mouth has been feeling very dry for about three weeks now.”
- “It’s there most of the day, but seems worse in the morning and at night.”
- “I’ve been drinking more water than usual but it doesn’t seem to help much.”
- “I’ve also been needing to urinate more frequently than usual.”
If the pharmacist asks:
- “My blood sugar has been a bit higher than usual lately - my last reading at home was around 16 mmol/L.”
- "I haven't had a diabetes review in maybe 6 months."
- “I don’t smoke and I drink about two glasses of wine a week.”
- “I haven’t had any recent illnesses or infections.”
- "I haven't changed my diet or anything, it's average. I try eat healthy but I do have a takeaway or two a week and a sugar snack here and there."
- Negative symptoms:
  - “I haven’t noticed any mouth ulcers or sores.”
  - “I haven’t had any difficulty swallowing or changes to my taste.”
  - “I haven’t tried anything for the dry mouth yet.”
  - "I don't snore."
  - "I don't mouth breathe."
  - "I don't have dryness elsewhere."
  - "I've never had radiotherapy."
  - "I don't have dentures - I'm only 68!"

At this point, the student should explain that your dry mouth is likely related to your poorly controlled diabetes and medications.

If the student offers you an over-the-counter treatment for dry mouth:

“I’ll take whatever you recommend.”

The student should also advise you on lifestyle measures and the importance of blood sugar control. If they do not mention this, prompt them by asking:

“Is there anything I can do at home to help with this?”
“Could my diabetes be making this worse?”

Mark Scheme

Introduction

0 / 2

Introduces themselves with an appropriate greeting

+1

Confirms patient details: name and date of birth

+1

Medical History

0 / 5

Confirms past medical history

+1

type 2 diabetes and hypertension

Confirms medication history including dose, frequency and indication, including OTC products and herbal remedies

+1

metformin BD, sitagliptin OD, amlodipine OD

Checks for allergies and clarifies nature of allergy

+1

Asks about smoking, alcohol and caffeine intake

+1

Considers other causes of dry mouth (Maximum of 1 mark awarded)

Mouth breathing or snoring

+1

Dry eyes or other sicca symptoms

+1

Previous head and neck radiotherapy

+1

Dehydration from another cause

+1

Diagnosis and Clinical Reasoning

0 / 2

Correctly identifies that the dry mouth is most likely a symptom of poorly controlled diabetes and explains this to the patient in lay terms

+1

For example: when blood sugar is high the body loses more fluid through the urine, which leaves you dehydrated and gives you a dry mouth and increased thirst. The dry mouth is a sign that your diabetes control needs attention, rather than a problem on its own.

Identifies that sitagliptin (a DPP-4 inhibitor) and amlodipine can contribute to dry mouth as a side effect Students should demonstrate awareness of medication-induced xerostomia.}

+1

Sitagliptin is associated with nasopharyngitis and upper respiratory symptoms; dry mouth is a recognised side effect but uncommon. Calcium channel blockers including amlodipine are associated with dry mouth as a side effect, although uncommon.

Management

0 / 5

Offers appropriate over-the-counter treatment for dry mouth: (Maximum of 3 marks awarded)

Saliva substitute spray (e.g. TePe oral spray or similar)

+1

Saliva substitute gel or pastilles

+1

e.g. TePe hydrating mouth gel which has mild peppermint and unflavoured options

Sugar-free chewing gum to stimulate saliva production

+1

Advises to avoid alcohol-containing mouthwashes which can worsen dryness

+1

TePe hydrating mouthwash is a suitable option and contains fluoride to prevent cavities.

Advises the patient to use only sugar-free products (e.g. sugar-free gum, sugar-free lozenges) given his diabetes

+1

This demonstrates patient-centred care and awareness of the interaction between diabetes management and OTC product selection.

Recognises that this requires referral for diabetes review rather than OTC management alone, and arranges timely contact with the GP or diabetes team

+1

A reading of around 16 mmol/L with osmotic symptoms warrants prompt review. Managing this as a routine OTC dry mouth request is a patient safety failure.

Safety Netting

0 / 2

Advises the patient to seek urgent medical attention if he becomes unwell, develops vomiting, drowsiness, confusion or breathlessness, or if his readings continue to rise

+1

Failure to safety net appropriately is a patient safety concern and should result in a fail.

Advises the patient to return to the pharmacy or contact his GP if the dry mouth persists once glucose control improves

+1

Communication

0 / 5

Knowledge and understanding of the topic is apparent throughout the consultation

+1

Demonstrates empathy and sensitivity, particularly regarding the impact of diabetes on the patient’s quality of life

+1

Checks patient understanding and signposts to further resources (e.g. NHS website, Diabetes UK)

+1

Concludes the consultation well by asking if the patient has any further questions

+1

The student did not say anything that could harm the patient

+1

This includes but is not limited to providing incorrect information, attributing the symptoms solely to medication, failing to recognise symptomatic hyperglycaemia, recommending a sugar containing product, managing the patient with OTC treatment alone without arranging diabetes review, neglecting to ask about allergies, or making an inappropriate referral.

Time Management

0 / 1

Completed the scenario in time and achieved 70% of marks

+1

Referral Criteria

References

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Referral Criteria for Dry Mouth (Xerostomia)

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