Name: Oral Symptoms 4
Creator: Abeer Aamir
Keywords: Ear Nose and Throat, Infectious Diseases, OTC, Responding to symptoms

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Scenarios

By Abeer Aamir • July 02, 2026 • Last reviewed: 27/07/2026 •

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Summary Intermediate

In this scenario, the community pharmacist counsels a patient who has come in complaining of bad breath (halitosis) and a sore mouth. The student must take a history, make a diagnosis, and suggest appropriate OTC and lifestyle recommendations.

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 Emiliano Matías (eh-mee-LYAH-noh mah-TEE-ahs).

Opening statement: ‘Hello, I’ve been having really bad breath lately and my mouth feels quite sore. My daughter said I should pop in and speak to the pharmacist because my dentist is really difficult to see.’

Patient information:

To be given if the student asks.

Name: Emiliano Matías
Age: 86
Past medical history:
- ‘I had a chest infection about three weeks ago.’
Medication history:
- "I was given a course of antibiotics for a week because of a chest infection, which I finished about two weeks ago. I don't remember the name"
- No other medications, no inhalers
Allergies:
- ‘No known allergies.’
Symptoms:
- ‘My mouth has been sore for about a week now.’
- ‘My daughter noticed my breath smells bad. First I was offended, but honestly, I can smell it too.’
- ‘My mouth feels quite dry and uncomfortable.’
If the pharmacist asks:
- Symptoms:
  - 'There are white patches inside my mouth and on my tongue. My daughter had a look and said they came away when she rubbed them with a tissue, and underneath looked red and a bit sore.'
  - ‘My mouth feels a bit like it’s burning or stinging.’
  - ‘I haven’t tried anything for the sore mouth yet.’
  - ‘I've never had this happen before.’
- Dentures:
  - ‘I wear full upper and lower dentures. I’ve had them for about 15 years.’
  - ‘I usually leave my dentures in overnight – I don’t take them out.’
  - ‘I rinse my dentures under the tap but I don’t use any special cleaning tablets.’
- Lifestyle factors:
  - ‘I don’t smoke and I drink very little alcohol.’
- Negative symptoms:
  - ‘I haven’t noticed any difficulty swallowing.’
  - ‘I haven’t lost any weight recently.’
  - ‘I don’t have any redness or soreness at the corners of my mouth.’

At this point, the student should inform you that they think you may have oral thrush (a fungal infection in the mouth).

The student should offer you treatment for oral thrush. Respond with:

‘I’ll take whatever you recommend.’

The student should also offer advice on denture hygiene and how to prevent recurrence. If they do not, prompt them by asking:

‘Is there anything I should do differently with my dentures?’

Mark Scheme

Introduction

0 / 2

Introduces themselves with an appropriate greeting

+1

Confirms patient details: name and date of birth/age

+1

Medical History

0 / 6

Confirms past medical history

+1

Confirms medication history including dose, frequency and indication, including recent antibiotic use and any OTC or herbal products

+1

Establishes recent antibiotic use, including timing and completion

Checks for medicines that interact with miconazole: warfarin, statins, sulfonylureas, phenytoin

Miconazole oromucosal gel is absorbed sufficiently to cause clinically significant systemic interactions. Recommending it without a medication check in an older patient is a patient safety failure.

Checks for allergies

+1

Asks about denture use: whether the patient wears dentures, how long they have had them, whether they are removed overnight, and the current cleaning routine

+1

Overnight wear and inadequate cleaning are major risk factors for oral candidiasis and denture stomatitis in older patients.

Asks about smoking and alcohol intake

+1

Clinical Decision

0 / 2

Makes a correct diagnosis of oral thrush (oral candidiasis) and explains it to the patient in lay terms

+1

For example: it sounds like you may have oral thrush, a fungal infection in the mouth. It is common after a course of antibiotics and in people who wear dentures, and it explains the white patches, the soreness and the change in your breath.

Identifies relevant risk factors contributing to the diagnosis

+1

Recent antibiotic use, denture use and poor denture hygiene

Management

0 / 5

Recommends miconazole oromucosal gel 2%, 2.5 ml applied four times daily after meals

+1

Nystatin oral suspension is an alternative but is prescription only, requiring GP referral if miconazole is unsuitable

Provides clear instructions on use (Maximum of 3 marks awarded)

Remove the dentures before applying the gel

+1

Hold the gel in the mouth for as long as possible rather than swallowing straight away

+1

Avoid eating or drinking immediately after application

+1

Continue treatment for seven days after symptoms have resolved

+1

Advises applying the gel to the fitting surface of the dentures as well as to the mouth

+1

Dentures harbour Candida and act as a reservoir for reinfection if not treated alongside the mucosa.

Advice

0 / 6

Advises removing the dentures overnight, every night

+1

Advise the patient to clean dentures thoroughly with a denture brush (eg. TePe Denture Care Brush) and denture cleaner (not toothpaste) before soaking

+1

Advises soaking the dentures daily in a proprietary denture cleaning solution, or in dilute sodium hypochlorite for full acrylic dentures

+1

Hypochlorite must not be used on dentures containing metal components.

Advises brushing the gums, palate and tongue with a soft brush while the dentures are out

+1

Advises rinsing the mouth after meals and maintaining good oral hygiene

+1

Advises a dental review, recognising that dentures of this age are likely to fit poorly and that ill-fitting dentures cause mucosal trauma and predispose to recurrence

+1

Safety Netting

0 / 2

Advises the patient to return to the pharmacy or see their GP if symptoms do not improve within 7 days of starting treatment

+1

Advises the patient to seek urgent medical attention if they develop difficulty swallowing, chest pain, or worsening symptoms, as this may indicate spread of the infection

+1

Communication

0 / 5

Knowledge and understanding of the topic is apparent throughout the consultation

+1

Demonstrates empathy and is sensitive to the patient’s age and concerns about bad breath

+1

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

+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 or medication, misdiagnosing the condition, recommending miconazole without checking interacting medicines, neglecting to ask about allergies, failing to act on red flag symptoms, 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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