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

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Scenarios

By Abeer Aamir • July 07, 2026 • Last reviewed: 14/07/2026 •

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Summary Beginner

In this scenario, the Community Pharmacist counsels a patient who has come in complaining of tooth discomfort. The student must take a history, make an appropriate assessment, and advise on over-the-counter management and lifestyle measures.

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

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Student Instructions

Actor Instructions

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Mark Scheme

Introduction

0 / 2

Introduces themselves with an appropriate greeting

+1

Confirms patient details: name and age/date of birth

+1

Medical History

0 / 3

Confirms past medical history

+1

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

+1

Checks for allergies and documents the nature of the reaction

+1

The patient has an allergy to ibuprofen causing a rash. Recommending ibuprofen or any NSAID without checking for allergies is a patient safety failure.

Diagnosis / Assessment

0 / 1

Makes a correct assessment: wisdom tooth discomfort consistent with pericoronitis (inflammation around a partially erupted wisdom tooth)

+1

Pericoronitis is inflammation of the gum tissue surrounding a partially erupted wisdom tooth. It is the most common cause of wisdom tooth pain in young adults.

Management

0 / 4

Offers appropriate over-the-counter treatment, taking into account the ibuprofen allergy: (Maximum of 3 marks awarded)

Recommends paracetamol for pain relief (e.g. paracetamol 500mg–1g every 4–6 hours, maximum 4g in 24 hours)

+1

Does NOT recommend ibuprofen or any NSAID due to documented allergy

+1

Recommending ibuprofen or any NSAID to a patient with a documented ibuprofen allergy is a patient safety failure and should result in an automatic fail.

Recommends warm saline rinses to reduce local inflammation

+1

Provides instructions on how to use the recommended product(s)

+1

Advises the patient to see a dentist for further assessment and management of the wisdom tooth

+1

Pericoronitis requires dental assessment. The dentist may irrigate under the gum flap, prescribe antibiotics if infection is present, or consider extraction.

Lifestyle and Self-Care Advice

0 / 4

Lifestyle and self-care advice: (Maximum of 4 marks awarded)

Advise gentle warm saline rinses (half a teaspoon of salt in a glass of warm water) several times a day, especially after meals

+1

Advise to maintain good oral hygiene — brush teeth gently twice daily and use an interdental brush or floss carefully around the area

+1

Advise to avoid hard, crunchy or chewy foods that may aggravate the area

+1

Advise to avoid smoking, as this can worsen inflammation and delay healing

+1

Advise to stay hydrated and eat soft foods while symptomatic

+1

Safety Netting

0 / 2

Advises the patient to see a dentist as soon as possible (within a few days) for assessment

+1

Advises the patient to seek urgent medical attention (A&E or call 999/111) if they develop difficulty swallowing, difficulty breathing, facial swelling, high fever, or feel very unwell

These symptoms may indicate a spreading dental infection such as Ludwig’s angina, which is a medical emergency.

Communication

0 / 5

Knowledge and understanding of the topic is apparent throughout the consultation

+1

Demonstrates empathy and acknowledges the patient’s discomfort

+1

Ensures patient understanding and signposts to further resources (e.g. NHS website, 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: recommending ibuprofen or NSAIDs despite a documented allergy, failing to check allergies, failing to refer to a dentist, or failing to act on red-flag symptoms such as difficulty swallowing or facial swelling.

Time Management

0 / 1

Completed the scenario in time and achieved 70% of marks

+1

Referral Criteria

Referral Criteria for Wisdom Tooth Discomfort / Pericoronitis

A&E

Difficulty swallowing or breathing or speaking — may indicate spreading infection such as Ludwig’s angina, which is a life-threatening emergency
Significant facial swelling, particularly involving the floor of the mouth, neck, or throat or difficulty opening eye.
High fever with systemic signs of severe infection (e.g. rigors, confusion) - High temperature and rapid pulse rate, low Blood Pressure (BP) or High Respiratory rate.
Trismus (inability to open the mouth) with signs of spreading infection
Neurological signs (reduced consciousness, eye symptoms (diplopia (double vision), papilloedema, pupils dilated, proptosis.

Urgent GP Appointment

Localised swelling, pus, or discharge around the wisdom tooth area suggesting pericoronitis with infection
Symptoms not improving after 48–72 hours of over-the-counter management
Recurrent episodes of pericoronitis around the same tooth
Fever without signs of spreading infection
Patient unable to maintain adequate oral hygiene or nutrition due to pain

Routine GP Appointment

Routine dental review for assessment of wisdom tooth position and consideration of extraction
Persistent mild discomfort without signs of infection that has not resolved after self-care measures
Patient seeking advice on long-term management of partially erupted wisdom teeth

References

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Referral Criteria for Wisdom Tooth Discomfort / Pericoronitis

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