Name: Tooth Discomfort 3
Creator: Abeer Aamir
Keywords: Ear Nose and Throat,Health Promotion, OTC, Responding to symptoms

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Scenarios

By Abeer Aamir • July 02, 2026 • Last reviewed: 27/08/2026 •

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Summary Intermediate

In this scenario, the community pharmacist counsels a patient who has come in worried about cavities. The student must take a history and provide appropriate 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 Mohammed Ahmed (Moh-ham-med Aah-med).

Opening statement: “Hi, I’ve been drinking energy drinks pretty much every day for the past year and I’m worried I might be getting cavities."

Patient information:

Name: Mohammed Ahmed
Age: 21
Past medical history:
- “No significant medical history.”
Medication history:
- “I don’t take any regular medications.”
- “I sometimes take ibuprofen for headaches, maybe once or twice a week.”
Allergies:
- “None that I know of.”
Symptoms:
- “My teeth have been feeling sensitive, especially when I drink cold drinks or eat sweet things.”
- “It’s been going on for about two months now.”
- “The sensitivity is getting a bit worse over time.”
- “I haven’t noticed any visible holes or dark spots on my teeth.”
If the pharmacist asks:
- Energy drinks:
- “I drink about two to three cans of energy drinks a day"
- “I usually drink them throughout the day, sometimes sipping on them over a long period.”
- “I mainly drink energy drinks to stay awake for university work and gaming at night.”
- “I don’t really drink much water during the day.”
- Alcohol: “I drink alcohol occasionally at weekends, maybe three or four drinks.”
- Diet: “I eat a fairly sugary diet – lots of snacks and fizzy drinks. Maybe 3 chocolate bars and 1 fizzy drink a day on average”
- Dentist: “I haven’t been to the dentist in about two years. I think I'm registered to one but I have to ask my mum.”
- Oral routine: “I brush my teeth twice a day with a regular toothbrush, when I wake up and before going to bed.” “I don’t use a mouthwash or anything else.”
- Smoking: “I vape on nights out, maybe every other weekend.”
- Negatives:
  - “I don’t have any jaw pain or facial swelling.”
  - “I haven't noticed any bleeding gums or loose teeth.”

At this point, the student should explain to you that your energy drink consumption is likely contributing to dental erosion and tooth sensitivity, and that you are at risk of developing cavities. Be worried and hopeful they can provide guidance on what to do.

The student should offer you advice on how to protect your teeth and reduce the risk of further damage. If they do not, prompt them by asking:

“Is there anything I can do to protect my teeth?”

Mark Scheme

Introduction

0 / 2

Introduces themselves with an appropriate greeting

+1

Confirms patient details: name and date of birth

+1

Medical History

0 / 3

Confirms past medical history

+1

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

+1

Checks for allergies

+1

Social and Lifestyle History

0 / 4

Asks about oral hygiene habits (e.g. brushing frequency and timing relative to energy drink consumption)

+1

Brushing immediately after consuming acidic drinks can worsen enamel erosion as the enamel is temporarily softened by acid.

Asks about diet including other sugary or acidic food and drink intake

+1

Establishing frequency of sugary food

Asks about smoking and alcohol use

+1

Asks when the patient last visited a dentist and if they are registered to a dentist

+1

Lifestyle Advice

0 / 4

Provides broader lifestyle advice. Advises: (Maximum of 3 marks awarded)

To reduce or stop energy drink consumption

+1

To increase water intake throughout the day

+1

To reduce overall sugar and acidic food and drink intake

+1

TePe recommends no more than 2 snacks a day

To address the reason for energy drink use (e.g. sleep hygiene, caffeine dependence) and consider healthier alternatives

+1

Addressing the underlying reason for energy drink use (e.g. fatigue, poor sleep) is important for long-term behaviour change. NICE public health guidance supports brief interventions on diet and lifestyle in community pharmacy settings.

Mentions that regular ibuprofen use for headaches may be related to caffeine withdrawal and advises the patient to discuss this with their GP

+1

Caffeine withdrawal headaches are a recognised phenomenon. Regular ibuprofen use also carries its own risks (e.g. gastrointestinal effects) and should be flagged, especially when combined with high caffeine intake. Excellent students may consider whether the patient's regular ibuprofen use could constitute medication overuse headache

Safety Netting and Referral

0 / 2

Advises the patient to see a dentist as soon as possible given they have not attended in two years and are experiencing tooth sensitivity

+1

NICE guidance recommends regular dental check-ups. Given the patient’s symptoms and risk factors, prompt dental review is essential.

Advises the patient to seek urgent dental or medical attention if they develop jaw pain, facial swelling, or worsening symptoms

+1

These symptoms may indicate a dental abscess, which requires urgent treatment.

Communication

0 / 5

Knowledge and understanding of the topic is apparent throughout the consultation

+1

Demonstrates empathy and a non-judgemental approach

+1

Checks patient understanding and signposts to further resources (e.g. NHS website, Oral Health Foundation)

+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, advising the patient to brush immediately after consuming acidic drinks, failing to refer to a dentist, or missing red flag symptoms such as jaw swelling or facial pain.

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 Dental Erosion

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