Name: Tooth Discomfort 2
Creator: Abeer Aamir
Keywords: Health Promotion, OTC, Responding to symptoms

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By Abeer Aamir • July 07, 2026 • Last reviewed: 24/07/2026 •

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Summary Beginner

In this scenario, a community pharmacist consults a woman complaining of tooth sensitivity. The student must take a history, and provide appropriate lifestyle and self-care advice.

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 Priya Sharma (Pree-yah, Shar-mah).

Opening statement: “Hi, I’ve been getting really sharp pain in my teeth whenever I drink cold water. It’s been bothering me for a few weeks now and I’m not sure what’s going on.”

Patient information:

To be given if the student asks.

Name: Priya Sharma
Age: 22
Past medical history:
- “Nothing really. I had my wisdom teeth out two years ago but nothing else.”
Medication history:
- “I don’t take any regular medication. I occasionally take ibuprofen for headaches.”
Allergies:
- “An antibiotic when I was a child; I don't recall the name, but I think it started with a P.”
  - If they say 'Penicllin' say 'Yes that one! It gave me really itchy rash all over.'
Symptoms:
- “I get a sharp, shooting pain in my teeth when I drink cold water or cold drinks, but not when I drink anything hot.”
- “It started about three to four weeks ago and seems to be getting a bit worse.”
- “It affects mainly my front teeth and a couple on the side.”
- “The pain comes on quickly and goes away within a few seconds after drinking cold water.”
If the pharmacist asks:
- “I brush my teeth twice a day, morning and night.”
- “I use a hard toothbrush and I brush quite vigorously – I like to make sure my teeth are really clean because I saw a TikTok that said most people don't brush hard enough and end up with cavities.”
- “I do drink fizzy drinks and fruit juice quite regularly, maybe once or twice a day.”
- “I haven’t seen a dentist in about four years; I moved to the area for Uni and never registered. It's hard to find anywhere that does NHS patients”
- Relevant negatives:
  - “I have not noticed any bleeding from my gums.”
  - “I don’t have any toothache or pain that lingers for a long time.”
  - “I haven’t had any recent dental work done.”
  - “I don’t grind my teeth at night as far as I know.”
  - “I haven’t tried anything for it yet.”
  - “No swelling around my face or jaw, or pain when biting down.”
  - "I've never had acid reflux or heartburn, and I don't get a sour or acidic taste in my mouth, especially not in the mornings."
  - "I haven't thrown up for any reason in years."

At this point, the student should explain to you that your tooth sensitivity is likely caused by brushing too hard, which can wear away the enamel and expose the sensitive dentine underneath.

The student should offer you advice on how to change your brushing technique and recommend a suitable product. If they do not, prompt them by asking:

“Is there anything I can do to help with the pain?”

The student should also offer advice on diet and dental hygiene habits. If they do not, prompt them by asking:

“Are there any other changes I should make?”

Mark Scheme

Introduction

0 / 2

Introduces themselves with an appropriate greeting

+1

Confirms patient details: name and age/date of birth

+1

Symptoms

0 / 9

Ask about the patient's symptoms:

Sharp/shooting pain on exposure to cold stimuli

+1

Duration of symptoms

+1

3-4 weeks

Location of sensitivity

+1

front and side teeth

Pain resolves quickly after removing cold stimulus

+1

Whether the patient has had any recent dental work

+1

Ask whether the patient has tried anything to relieve symptoms, or visited a dental professional for advice

+1

Rules out red flag symptoms:

No persistent or spontaneous toothache

could indicate pulpitis or abscess

No facial swelling or signs of dental abscess

No pain on biting

could indicate cracked tooth or abscess

Medical History

0 / 2

Confirms medication history including dose, frequency and indication, including any over-the-counter products and herbal remedies

+1

Checks for allergies and clarifies nature of allergies

+1

Identifying the Cause

0 / 5

Asks about: (Maximum of 2 marks awarded)

Acid reflux

+1

Gastric acid reaching the mouth chemically dissolves enamel, classically on the palatal surfaces of the upper anterior teeth.

Bruxism

+1

Grinding teeth causes mechanical attrition of the surfaces

Vomiting

+1

Same acid mechanism as reflux. Causes include eating disorders, pregnancy, alcohol excess, chemotherapy and gastrointestinal illness, so ask about this sensitively

Asks about brushing technique: frequency, pressure used and type of toothbrush (hard vs soft bristles)

+1

Asks about dietary habits relevant to dental erosion (e.g. acidic drinks such as fizzy drinks or fruit juice)

+1

Correctly identifies aggressive/vigorous brushing as the likely cause of tooth sensitivity

+1

Aggressive brushing can wear away enamel and expose the dentine, leading to hypersensitivity.

Management

0 / 3

Recommends an appropriate over-the-counter product and advice (Maximum of 3 marks awarded):

Desensitising toothpaste containing potassium nitrate or stannous fluoride (e.g. Sensodyne)

+1

Advises rubbing the toothpaste directly onto the sensitive areas and not rinsing afterwards

+1

Advises a fluoride mouthwash used at a different time of day to brushing

+1

Advises that relief may take up to two to four weeks of regular use

+1

Safety Netting

0 / 2

Advises the patient to see a dentist for a routine check-up, especially as they have not attended in four years

+1

Advises the patient to seek urgent dental attention if symptoms worsen, become persistent, or if they develop facial swelling, severe toothache or pain on biting

+1

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

Communication

0 / 5

Knowledge and understanding of the topic is apparent throughout the consultation

+1

Demonstrates empathy and is non-judgemental about the patient’s brushing habits

+1

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

+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, misidentifying the cause, 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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