Name: Oral Symptoms 5
Creator: Leya Luhar
Keywords: Ear Nose and Throat,OTC,Responding to symptoms

Report a problem

Scenarios

By Leya Luhar • August 31, 2026 • Last reviewed: 2026-08-31 •

Ready to dive into this scenario?

Log in or sign up to add it to your favourites and show your support

Add to Favourites

Summary Intermediate

In this scenario, a community pharmacist consults an elderly patient who has come into the pharmacy with sore, painful gums under their dentures. The student must take a history, make an appropriate diagnosis, and advise on suitable over-the-counter management and referral.

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 Dorothy Higgins (Dor-oh-thee, Hig-inz).

Opening statement: "Hello love, I'm sorry to bother you. I've been trying to ring my dentist all morning but I just can't seem to get through, and the surgery is miles away. I've got a sore spot under my bottom denture and I didn't know where else to go."

Patient information:

Name: Dorothy Higgins
Age: 80
Date of Birth: 14/03/1946
Past medical history:
- ‘I have high blood pressure.’
Medication history:
- ‘I take a couple of tablets for my high blood pressure. My daughter helps me with them; I don't know what they are.'
- ‘I don’t take anything else.'
Allergies:
- ‘None that I know of.’
Symptoms
- "There's a sore spot under my bottom denture. It's been about five days."
- If asked to describe it: "It's a small raw patch on the gum, on the left side towards the back. It looks a bit red around it."
- Pain: "It's sore when I eat, especially anything hard. It's easier if I take the denture out, but then I can't eat at all."
- Pattern: "It was just a bit tender at first. It's got worse over the five days."
- Previous episodes: "I've had the odd sore spot over the years, but they've usually settled in a day or two. This one hasn't."
  
  Denture history (give if asked)
- "I've had these dentures about fifteen years."
- Fit: "They have got a bit loose over the last year or two, now you mention it. The bottom one moves about when I'm eating."
- Taking them out: "I take them out at night and put them in a glass of water. My mother always told me to."
- Cleaning: "I give them a brush every morning with a bit of soap and water."
- Dentist: "It must be three or four years now. I keep meaning to go."
Negative symptoms (give if asked)
- "No, no white patches or coating anywhere in my mouth."
- "The roof of my mouth is fine, it's just the one spot on the bottom gum."
- "No bleeding, no."
- "No, no difficulty swallowing at all."
- "No lumps or swellings in my mouth or neck, and nothing's changed with my voice."
- "I haven't lost any weight. If anything I've put a bit on."
- "No numbness or tingling in my lip or chin."
- "I'm eating alright otherwise, just carefully."
Lifestyle (give if asked)
- "I do smoke, about five a day. I have done since I was seventeen."
  - If asked about quitting: "I've never really tried. I'm eighty, love, I thought the damage was done."
- "I have a small glass of sherry in the evening, nothing more."

Access to the dentist

"I tried ringing this morning but I couldn't get through, and the surgery's about twelve miles away. My daughter works, so she can only take me at weekends and they're shut then."
- If asked whether you are registered: "I was registered, but I've not been in three or four years so I don't know if I still am."

How to respond to the student

If the student explains that the sore area is caused by the denture rubbing because it no longer fits properly: "Oh. I thought they lasted forever, dentures."
If the student tells you to leave the denture out to let it heal: "But how am I meant to eat? I can't manage anything without it."
- Only accept a plan if the student negotiates something workable, for example leaving it out at all times except meals, or leaving it out for a set number of hours a day.
If the student offers something for the soreness: "I'll take whatever you think is best, thank you."
If the student offers to help you contact the dentist, or suggests NHS 111 or an urgent dental access line: "Oh that would be ever so helpful, thank you so much."

If the student has not identified the cause by roughly eight minutes, prompt once:

"Do you think it's the denture doing it?"

If the student has not addressed getting you seen by a dentist, prompt once:

"So what do I do about the dentist, then?"

Mark Scheme

Introduction

0 / 2

Introduces themselves with an appropriate greeting

+1

Confirms patient details: name and age or date of birth

+1

Denture History

0 / 4

Establishes how long the patient has had her dentures

+1

about fifteen years

Asks about denture fit and elicits that the lower denture has become loose and moves when eating

+1

Asks about denture care routine and establishes that they are removed overnight and cleaned daily

+1

Denture hygiene here is adequate. The problem is fit, not cleanliness.

Establishes when the patient last saw a dentist and whether she remains registered

+1

Medical and Medication History

0 / 4

Confirms past medical history and specifically excludes diabetes and immunosuppression

+1

Both predispose to oral candidiasis and to delayed healing, and their absence supports the mechanical diagnosis.

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

+1

Checks for allergies and clarifies the nature of any allergy

+1

Asks about smoking and alcohol, and quantifies both

+1

Clinical Decision

0 / 3

Correctly identifies traumatic denture ulceration caused by an ill-fitting denture, and explains this to the patient in lay terms

+1

The jaw bone continues to shrink after teeth are lost, so dentures that once fitted become loose over time. A loose denture rubs against the gum and causes a raw, ulcerated area. Fifteen-year-old dentures are very unlikely still to fit.

Does not misdiagnose the presentation as oral candidiasis, and does not recommend an antifungal

+1

There are no white patches, no palatal involvement, no generalised soreness, adequate denture hygiene, no overnight wear, no antibiotics, no inhaled steroid and no diabetes. Recommending an antifungal here is treating a condition the patient does not have.

Recognises that dental assessment is required

+1

Symptomatic relief will not stop the trauma recurring. Only adjustment, reline or replacement of the denture will.

Management

0 / 4

Arranges or facilitates dental review rather than simply advising the patient to contact her dentist

+1

This can be done by offering to help her contact the dental practice from the pharmacy, signposting to NHS 111 or the local urgent dental access service, or advising on how to find a practice accepting NHS patients if she is no longer registered

Offers appropriate symptomatic relief (Maximum of 1 mark awarded)

Simple analgesia such as paracetamol, checking suitability

+1

A saline mouth rinse, warm salt water, to soothe and keep the area clean

+1

A topical oral analgesic gel or an antiseptic mouthwash for short term use

+1

Advises reducing wear of the lower denture to allow the area to heal, and negotiates a plan the patient can realistically follow given that she cannot eat without it

+1

Acceptable approaches include wearing it for meals only, or leaving it out for defined periods each day.

Advises on softer foods and avoiding hard, sharp or spicy foods while the area heals

+1

Health Promotion

0 / 2

Offers brief smoking cessation advice and signposts to stop smoking support, without lecturing or dismissing her age as a reason not to

+1

Smoking impairs mucosal healing and is the principal modifiable risk factor for oral cancer. Cessation benefits apply at any age.

Advises on the importance of regular dental review even with full dentures

+1

Denture wearers still require examination of the oral mucosa, including screening for oral cancer, and periodic assessment of denture fit.

Safety Netting

0 / 2

Advises the patient to seek urgent dental or medical assessment if the sore area has not healed within three weeks

+1

A non-healing oral ulcer of three weeks or more requires urgent referral under the suspected head and neck cancer pathway. This is the single most important piece of safety netting for an 80 year old lifelong smoker.

Advises her to seek help sooner if the area worsens, if she develops facial swelling, fever, spreading pain or difficulty swallowing, or if new lumps or numbness appear

+1

Communication

0 / 6

Responds to the patient's apologetic manner appropriately and reassures her she was right to come in

+1

Knowledge and understanding of the topic is apparent throughout the consultation

+1

Avoids jargon and adjusts the explanation when the patient indicates she has not understood

+1

Checks patient understanding and signposts to further support

+1

Concludes the consultation well by summarising the plan and asking if she has any further questions

+1

The student did not say anything that could harm the patient

+1

This includes but is not limited to misdiagnosing the condition as oral thrush, recommending an antifungal without indication, advising the patient to adjust or repair the denture herself, recommending denture adhesive as a solution to a poorly fitting denture, failing to safety net the three week rule, failing to check allergies before recommending analgesia, or failing to act on red flag symptoms.

Time Management

0 / 1

Completed the scenario in time and achieved 70% of marks

+1

Referral Criteria

Referral Criteria for Sore Gums Under Dentures

A&E

Severe allergic reaction: Signs such as difficulty breathing, facial swelling, or severe rash after using lice treatment may indicate a serious allergic reaction
Swelling of the floor of the mouth, or elevation or displacement of the tongue
Signs of sepsis: fever with rigors, confusion, rapid heart rate, low blood pressure, feeling very unwell
Uncontrolled bleeding from the mouth
Suspected anaphylaxis or severe allergic reaction to any product used or recommended
Complete inability to swallow, including inability to swallow saliva

Urgent GP Appointment

Persistent itching or irritation: If severe itching or skin irritation continues despite treatment, this may suggest treatment resistance or misuse.
Severe scalp irritation: Significant redness, swelling, or skin reactions to lice treatments should be evaluated by a GP
Infestation in vulnerable individuals: Infestations in young children, elderly, or immunocompromised individuals may require closer medical attention.
The patient meets suspected cancer referral criteria and no dental route is accessible, so that the GP can initiate the two week wait referral

Routine GP Appointment

Symptoms suggest an undiagnosed systemic contributor to poor oral healing, such as unexplained fatigue, recurrent infections or possible undiagnosed diabetes
Recurrent oral ulceration with no local cause, which may need investigation for haematinic deficiency or an underlying condition
Support is needed with smoking cessation and the patient prefers or requires a GP route rather than pharmacy or the local stop smoking service

References

See our plans

Did this scenario help you?

Log in or sign up to add it to your favourites and show your support

Add to Favourites

Comments(0)

SIGN UP TO OUR NEWSLETTER

Ready to dive into this scenario?

Oops, You Failed

Quiz Required to View Scores

Question 1 of 5

Question 2 of 5

Question 3 of 5

Question 4 of 5

Question 5 of 5

Thanks!

Referral Criteria for Sore Gums Under Dentures

We hope you enjoyed this free resource.

Did this scenario help you?

Subscribe to our newsletter