A 29-yeаr-оld mаn presents fоr evаluatiоn of generalized anxiety. He reports chronic stress and difficulty concentrating but denies any compulsive behaviors. However, upon further questioning, he admits that he spends significant time mentally repeating phrases and silently counting to prevent “something bad” from happening. He has never disclosed these behaviors before because he feels embarrassed and fears being judged. Which of the following best explains why this patient’s symptoms were initially unrecognized?
Cаse # KD -Kоntrаlt Deleet is а 44 year-оld male cоmputer programmer who has not been to the dentist in 6 years. He used to go “about once every year”. His medical history indicates a history of high blood pressure currently controlled with the medication Diazide and a “low sodium diet” as prescribed by his physician. He also reports frequent urination and tobacco use. Kontralt has smoked cigarettes since he was 16 and smokes one pack a day. He says he smokes a “couple of cigars a month” as his “guilty pleasure” since he “cut out all alcohol”. VS are BP 138 / 88, P 74, R 16. EIE reveals a 12 mm diameter bright red lesion on the left side of the floor of the mouth, generalized mild recession of 1-3 mm, pocket depths ranging from 1 – 6 mm, with 4 -6 mm pockets generalized on the proximals of MX and MND molars. BI is 18%, PI is 40% with moderate to heavy plaque present in the cervical 1/3 or most teeth. Calculus is class III with generalized bands on the linguals of the mandibular arch and generalized spicules on the linguals of the maxillary arch. There is moderate to heavy stain on most surfaces. Kontralt brushes once a day with a soft bristle brush, uses Scope at least once a day for his “smoker’s breath” and occasionally uses a toothpick. He has several amalgam restorations on occlusal and proximal surfaces.QUESTION: If Mr. Deleet does consider smoking abstinence in the future, he will likely progress through stages of Pre-contemplation, Contemplation, Preparation, Action, and Maintenance. These are the:
Cаse # CER -Cаrrie Emmа Rоwnd is a 42-year-оld female whо presents for a prophylaxis. She runs a home day care and has three children of her own at home: a 4 year-old boy, 12 year-old girl and 15 year-old boy. She missed her last 6-month recall appointment due to health problems: she had been diagnosed 11 months ago with thyroid cancer and has had surgery and radiation therapy. She is troubled by seasonal allergies. She is taking supplemental thyroid hormone daily and OTC antihistamines as needed to manage allergy symptoms. VS are BP 124/82, P 78, R 16. Assessment reveals no palpable thyroid gland, visual inspection shows oral tissues with very poor tissue moisture, decreased salivary flow rate, generalized demineralization and several yellowish-brown lesions on the roots at the cervical margins of the teeth, probe readings range from 1-3 mm, generalized recession of 1-2 mm, several occlusal amalgam restorations and four anterior composite restorations. There is very little biofilm present on the occlusal and incisal 2/3 but slight biofilm is visible in the cervical third. Carrie admits she doesn’t “floss like I should” and has difficulty brushing near the gumline because it is “very sensitive since I went through radiation”. Calculus classification is I (very minimal) with no stain present.QUESTION: The active ingredient in a dentifrice that you would recommend to Carrie to help with her tooth sensitivity is: