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The most distinctive early sign is called a chancre (a shallow diabetes type 1 treatment guidelines discount 10 mg glipizide otc, painless ulcer with a firm border that is usually located on genital surfaces diabetes type 1 non insulin dependent buy discount glipizide 10 mg on line, but possibly on other areas of the body) diabetes type 2 need insulin cheap 10mg glipizide mastercard. A skin rash and/or patches in the mouth/throat may then appear and may last 2–6 weeks infant diabetes signs symptoms buy glipizide 10 mg online. Patients may remain asymptomatic throughout life or may progress to the late destructive stages of the disease. In an untreated female, syphilis may be transmitted to a fetus regardless of the stage of the disease. Infectious Period Appropriate antibiotic treatment ends infectiousness within 24 hours. Control of spread involves an interview with the patient and tracing of all sexual contacts by public health officials for medical examination and treatment. Adequate treatment will limit spread from the primary site to other organs and from one individual to another. The untreated disease may become a very significant health problem in the years ahead. Congenital syphilis such as the infection of a newborn with syphilis contracted from the mother, is a serious and unnecessary tragedy since this disease can be diagnosed and treated effectively. While trichomoniasis infects both males and females, males seldom have any symptoms. Control of Spread Although the male is seldom symptomatic with trichomoniasis, control of spread and reinfection usually involves concurrent referral of male sexual contacts for medical examination and treatment. The most prevalent types of vaginitis are trichomoniasis (trich), candidiasis (yeast), and bacterial vaginosis (Gardnerella vaginitis, nonspecific vaginitis). Mode of Transmission Vaginal infections may be transmitted by intimate sexual contact but symptoms also may originate from excessive douching, use of birth control pills, certain antibiotics, and other sources such as allergic reactions to vaginal products. If the referred student is of the age of 14 or older and is otherwise competent, written consent from the student must be obtained prior to disclosing such referral and/or treatment information with the student’s parent/guardian. Unlike chickenpox, lesions are at the same stage of development at the same time no matter where they are on the body. Crusts begin to form in about 14 days and begin to separate during the third week. Smallpox vaccine is used in special circumstances to vaccinate some military personnel and laboratory workers. The vaccine is created using a different but related virus that causes the same kind of lesion but in a limited area. Immediately report to your local health jurisdiction by telephone a suspected case of smallpox or smallpox vaccine rash. Cover lesions from smallpox vaccine, which is a different virus that is also contagious. Use standard precautions including gloves for any contact with dressings or with articles soiled with fluid or scabs from skin lesions. Dispose of all dressings in biohazard bags or disinfect dressings with 1:10 bleach and water solution. Follow recommendations from your local health jurisdiction about exclusion from school. This site includes updates, links, and education options along with general information. Characteristically, the rash spares the area around the mouth and inside of the elbow. Symptoms include red sores or blisters, often on the face or areas that are scratched like an insect bite (see Impetigo). Necrotizing fasciitis (flesh-eating bacteria) is caused by Group A strep, the same bacteria that causes strep throat and impetigo. Unlike strep throat and impetigo, which are common and easy to treat, necrotizing fasciitis is very rare and more difficult to treat. As with all unidentified rashes, especially those accompanied by fever or illness, make referral to a licensed health care provider. A person can move the infection from one part of the body to another by scratching. Report to your local health jurisdiction suspected or confirmed outbreaks associated with a school. Those with a positive throat culture should be excluded until at least 24 hours after antimicrobial treatment is initiated. When throat cultures are done on a cluster of students to check for strep, there will almost always be some who test positive but are without any symptoms. Significant increases in the number of sore throats or increases above normal in school absenteeism (above 10 percent) should be referred to your local health jurisdiction for epidemiologic investigation. Years of prescribing antibiotics for nonbacterial infections and failing to complete the full courses of treatment have promoted the development of antibiotic-resistant bacteria. Tetanus growth in a deep wound produces a toxin that can cause localized spasm and pain in the muscles at the site of injury, or severe generalized muscle spasms most marked in the jaw and neck, generalized pain, even seizures, and death. Tetanus has not been reported in the United States in individuals who received an adequate primary immunization series. Mode of Transmission Transmission is through contamination of a wound by soil, dust, water, or articles, especially those that have been contaminated with animal feces or manure. Deep puncture wounds are a particular risk because the bacteria grows in a low-oxygen or oxygen-free environment. Adults who have not received a Tdap booster should get one, then a booster dose of Td every ten years during their lifetime. Tick size varies depending on its developmental stage and recent feeding, varying from 1/8 to 1/2 inches in length. Rare late symptoms include recurring joint pain, heart disease, and nervous system disorders. These include rare reports of babesiosis, anaplasmosis, Rocky Mountain spotted fever, and tick paralysis. If the student reports a known tick bite and the tick is no longer attached, wash the bite site thoroughly with soap and water. If symptoms develop, the student should be evaluated by his/her health care provider. Be sure the parent informs the provider about the recent tick bite, when the bite occurred, and where the student most likely acquired the tick. Refer suspected cases of any tick-borne illness to a licensed health care provider. If spending time outdoors in risk areas (woody, brushy, or grassy) students and staff should be instructed to: 1. If staying overnight in wood cabins or structures in rural or wilderness areas, be sure that the cabins are not infested with rodents that could bring in soft ticks. Infants, however, are particularly susceptible to rapidly developing disease at the time of initial infection. Most cases of untreated infection (90 percent) become dormant and never progress to active disease. Your local health jurisdiction staff will advise when treated student or staff members may return to school. They may be smooth and flat (as plantar warts on the soles of the feet), raised (as on fingers, knees, and hands), or elongated (as on face and neck). Mode of Transmission Warts are usually transmitted by direct skin-to-skin contact with a person who is shedding the virus. The virus is shed at least as long as visible lesions persist and shedding continues intermittently when warts are not present. Warts may fail to disappear even with repeated treatment and they may recur after an apparent cure. They may be treated with locally applied chemicals, surgery, cautery, or freezing with liquid nitrogen. Clean and disinfect floors, mats, and other equipment if a large number of cases of plantar warts are present. Students with plantar warts should be urged to wear thongs on their feet for showering or be excused from showering until warts disappear.

During a fever diabetes oatmeal generic glipizide 10 mg with mastercard, do not overdress your child in warm clothes because the body is too hot gestational diabetes signs of high blood sugar glipizide 10mg for sale. Turn the child’s head and body to blood glucose 96 mg dl cheap glipizide 10mg fast delivery the side to diabetes prevention nhs buy glipizide 10mg with amex allow vomit or saliva to run out of the mouth. If the seizure lasts for more than 3 minutes or there is trouble breathing, call 911. Copyright © 2015 by the American Academy of Pediatrics and the American College of Emergency Physicians Emergency Department Name Emergency Department Address Emergency Department Phone Number Fever Fever is a symptom of an infection. Fever is not harmful, and the main reason to treat a fever is to make you more comfortable. Under arm Ear (tympanic) Normal (axillary) or or temporal Temperatures By Mouth Rectal forehead scan) Fever Degrees F 98. If your child is older than 6 months, you might also use ibuprofen every 6 hours as needed. Caution: Don’t Suspension use old form and new Extra of infant drops infant drops Chewable strength (80 mg (160 mg 80mg Adult tabs 500 mg Age Weight Dose per 0. Ibuprofen (Motrin, Advil) fever medicine doses every 6 hours (10 mg/kg): Dosing by weight is more accurate. Infant drops Suspension Tablets Age Weight Dose (40 mg per mL) (20 mg per mL) (200 mg) 3 – 6 mos 13 lbs, 6 kg 60 mg 1. Fractures and many sprains should be protected and immobilized (held steady in a wrap, brace, splint, or cast) until they heal. If an X-ray is obtained, a radiologist (X-ray specialist) will read this within 24 hours. The patient should be notifed of any different fndings from what was discussed at the visit, but to be sure, please call your doctor’s offce and ask them to double check the X-ray reading. Sometimes fractures are not seen on the frst X-ray but can be seen on later X-rays. Most of the time, sprains and strains improve every day, while fractures take longer to improve. Rest the injured area and keep it elevated (above heart level) as much as possible. Some recommend giving ibuprofen (Motrin, Advil), but this can cause increased bruising and bleeding in an injury. If you have an elastic bandage, splint, or sling, adjust your bandage, splint, or sling if it becomes too tight or if it causes swelling. Some ankle and foot injuries (such as ankle sprains), treated with an elastic bandage or removable ankle brace, heal better if you gently walk on the injured limb. See your doctor for a re-check visit tomorrow or as soon as possible if not better. Nail or skin color (pale, bluish, or deeper in color than the other side) changes. Copyright © 2015 by the American Academy of Pediatrics and the American College of Emergency Physicians Emergency Department Name Emergency Department Address Emergency Department Phone Number Headache You have been evaluated for a headache. Most headaches are not serious and are usually relieved by acetaminophen (paracetamol, Tylenol) or ibuprofen (Motrin, Advil). Common causes include migraines, stress, eye strain, and infections (sinus or dental). Rarely headaches can indicate a serious disease, such as infection, high blood pressure, or bleeding in the brain. Sometimes the initial examination or test results are normal, even when there is a more serious problem, so it is important to follow up with your doctor for further evaluation. Copyright © 2015 by the American Academy of Pediatrics and the American College of Emergency Physicians Emergency Department Name Emergency Department Address Emergency Department Phone Number Head Injury (Concussion) the doctor has determined that your head injury can be safely observed at home. A concussion (injury to the brain) can cause sleepiness, headache, dizziness, or vomiting. Wake him/her up every 3 hours to check speech, recognition, alertness, and headache. Give acetaminophen (paracetamol, Tylenol) for headache as recommended by the doctor. Ibuprofen (Motrin, Advil), naproxen (Naprosyn), and aspirin can cause bleeding and bruising, so don’t use these. See your doctor for a recheck visit tomorrow or as soon as possible if not better. Worsening dizziness or unsteadiness on feet occurs or the child can’t walk normally. Copyright © 2015 by the American Academy of Pediatrics and the American College of Emergency Physicians Emergency Department Name Emergency Department Address Emergency Department Phone Number Hives (Urticaria) Hives are itchy, pink puffy patches on the skin that can change in size and location. Most of the time hives are caused by an allergic reaction that most often lasts for 1 or 2 days. Common causes include peanuts, strawberries, shellfsh, plants, medicines, pets, bee stings, and food preservatives. Take an antihistamine, such as diphenhydramine (Benadryl), loratadine (Claritin), or cetirizine (Zyrtec). Antihistamine medicines (eg, Benadryl) can help with itching, but they do not help the rash. Copyright © 2015 by the American Academy of Pediatrics and the American College of Emergency Physicians Emergency Department Name Emergency Department Address Emergency Department Phone Number Nosebleeds (Epistaxis) Nosebleeds are common. They are usually caused by dryness inside the nose along with irritation from rubbing, picking, or cold symptoms. Nosebleeds can also be caused by an injury, dry climate, medications, or an object in the nostrils. Nosebleeds are generally harmless and most will stop by gently pinching the nostrils for 10 to 20 minutes. Sometimes a nosebleed needs additional treatment, such as flling the nose with gauze or a balloon to stop the bleeding. Rarely, nosebleeds that last for a long time are caused by a problem with the blood clotting system. If the inside of the nose is dry, coat the inside of the nose with petroleum jelly (Vaseline). If a balloon or gauze packing is placed, it should be removed by the doctor in 1 or 2 days. Do not take ibuprofen (Motrin, Advil), naproxen (Aleve), or aspirin because these medicines make you bruise and bleed more easily. Copyright © 2015 by the American Academy of Pediatrics and the American College of Emergency Physicians Emergency Department Name Emergency Department Address Emergency Department Phone Number Lab Cultures: Please Check Results the doctor has ordered a test to fnd out whether there are bacteria (germs) in a test sample. Cultures of a sample (usually blood, urine, or a throat swab) must incubate (grow) in the lab for 2 or 3 days (or longer). During this time, the lab is looking for the growth of bacteria (germs) from the sample to fnd out what type of infection you have. This test is necessary because most bacterial infections cannot be determined right away and it helps determine what medicines your child needs. If your culture grows some bacteria (germs), the lab or the emergency department is supposed to call you or your doctor. Because no system is perfect, we recommend that you check the culture result through your doctor’s offce (please double-check). Culture results are kept in the lab, medical records, and the hospital’s computer system. Ask the nurse or receptionist at your doctor’s offce to call our lab to check your culture results. If you don’t have a doctor, then you should make an appointment tomorrow to see the doctor of your choice or call the emergency department for your culture result. If the culture result is negative (the culture grows no bacteria), that’s good news. If a culture grows bacteria, a second test is usually done in the lab to determine which antibiotic will kill the bacteria. If you are already taking antibiotics, make sure that this second test confrms that the antibiotic is one that will work.

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However diabetes insipidus blood osmolality discount glipizide 10mg, no single complication during pregnancy or birth has been consistently identified as being asso ciated with the later development of the signs of Asperger’s syndrome diabetes diet sample discount glipizide 10 mg amex. There also appear to diabetes prevention program brochure generic glipizide 10mg be more children with Asperger’s syndrome than we would expect who were born either pre-term (36 weeks or less) or post-maturely (42 weeks or more) (Cederlund and Gillberg 2004) rapid onset diabetes in dogs cheap glipizide 10mg on-line. There may be two subgroups of children with Asperger’s syndrome who have macrocephalus, one which includes children who had a large head at birth, and one which includes children who showed a rapid increase in brain size during early infancy. The initial acceleration eventually slows, so that in later childhood typical children have ‘caught up’, such that the differ ences in head circumference may not be so conspicuous when the child is about five years old. We know that brain enlargement can occur in young children with Asperger’s syndrome and autism. There is also preliminary information to suggest that the frontal, temporal and parietal, but not the occipital, areas of the brain are enlarged (Carper et al. Sometimes having a rapidly growing and relatively big brain, or at least parts of it, is not an advantage. Clinical experience indicates that it is extremely important that the diagnosis is explained as soon as possible and preferably before inappropriate compensatory reactions are developed. Children who are younger than about eight years may not consider themselves as particularly different to their peers, and have diffi culty understanding the concept of a developmental disorder as complex as Asperger’s syndrome. The clinician or parents can then explain that there is another form of reading, namely ‘reading’ people and social situations, and that we have programs to help children who have this particular reading difficulty. There are many books that can help explain the diagnosis and I have provided a list of recommended books on explaining the diagnosis in the Resources section towards the end of the book. Parents can supplement an explanation of Asperger’s syndrome by encouraging the child to read story books with the person with Asperger’s syndrome being the hero. I arrange a gathering of family members, including the child or adolescent who has recently been diagnosed as having Asperger’s syndrome. The clinician comments on each quality and difficulty nominated by the child with Asperger’s syndrome and then explains that scientists are often looking for patterns; when they find a consistent pattern, they like to give it a name. He published the first clinical descrip tion that has become known as Asperger’s syndrome. The discussion continues with an explanation of how some of the child’s talents or qualities are due to having Asperger’s syndrome, such as his or her extensive knowledge about spark plugs, ability to draw with photographic realism, attention to detail and being naturally talented in mathematics. This can include the advantages of programs to improve social understanding, Cognitive Behaviour Therapy and/or medication that can help with emotion management, and ideas and encouragement to improve friend ships. The clinician provides a summary of the person’s qualities and difficulties that are due to having Asperger’s syndrome, and mentions successful people in the areas of science, information technology, politics and the arts who benefited from the signs of Asperger’s syndrome in their own profile of abilities (Fitzgerald 2005; James 2006; Ledgin 2002; Paradiz 2002). Hans Asperger wrote that: It seems that for success in science or art, a dash of autism is essential. When explaining the development of the profile of abilities associated with Asperger’s syndrome to an adolescent or adult, I sometimes use the metaphor of a clearing in a forest. The person may then see Asperger’s syndrome as an explanation of his or her talents as well as difficulties. The Attributes Activity closes with explanation of some of the clinician’s thoughts on Asperger’s syndrome. The person prioritizes the pursuit of knowledge, perfection, truth, and the understanding of the physical world above feelings and interpersonal experiences. The person’s qualities and difficulties are also included in a report for the family or as a Social Story™ for a child. Another option is for the specialist and parents to write the child a letter outlining the nature of Asperger’s syndrome, the advantages and disadvantages of having Asperger’s syndrome and infor mation tailored to the child (Yoshida et al. I prefer to use the term Asperger’s syndrome rather than Asperger’s disorder when explaining the diagnosis, as the child can be confused regarding the concept of a disorder. He continues, ‘I’m going to write the author of this book and tell her she used an incorrect term. Children may be concerned about how their peers will respond to the news and any potential negative reaction. The clinician will examine and discuss the issues surrounding disclosure for the client, based on his or her circumstances, the advantages and disadvantages of certain people knowing, and how much information to disclose. The child’s opinion is respected regarding the question of whether or not peers should be told. Carol Gray has developed a program, the Sixth Sense, to explain Asperger’s syndrome to a class of children in an elementary or primary school (Gray 2002b). She has designed a range of classroom activities based on learning about the five senses that is extended to include a sixth sense, the perception of social cues. Children can then discover what it would be like to have difficulty perceiving the social cues and thoughts and feelings of others, and what they can do to help someone develop the sixth sense. We now have other published resources to help explain Asperger’s syndrome to peers and siblings (see the Resources section towards the end of the book). An adult who has recently been diagnosed will also need to discuss who to tell and how to explain Asperger’s syndrome to the family, social network and work associates. Some adults have a more reserved personality and are very cautious regarding disclo sure, deciding to limit the news to carefully selected individuals. Chapter 4, on teasing and bullying, describes how a child with Asperger’s syndrome can retaliate with actions that contravene school and criminal law. The social naivety and immaturity of adolescents with Asperger’s syndrome can also make them vulnerable to being ‘set up’ by peers, who encourage them to commit an offence. A malicious subgroup Some of the children Asperger diagnosed as having autistic personality were originally referred for behaviours that today would be indicative of conduct disorder (Hippler and Klicpera 2004). Within this group, he identified a very small minority of children who act maliciously with deliberate intention and sometimes satisfaction. When the child with Asperger’s syndrome feels alienated from peers, due to a lack of social competence and acceptance, and perhaps further alienated because of learning difficul ties or superior intellectual abilities, he or she can achieve authority in a social situation by intimidation. By surrendering to the child’s authoritarian and egocentric demands they have unwittingly reinforced such behaviour. Some adolescents with Asperger’s syndrome realize they have difficulties with empathy and understanding the emotions of other people, and develop a special interest in creating situations and making statements as a ‘psychological experiment’ to be able to predict someone’s emotional reaction. The statements can be extremely disturbing for the subject in the experiment: for example, an adolescent informing his aunt, in a way that is credible, that her much-loved pet has just been killed by running in front of a passing car. The act or ‘experiment’ is malicious and intended to explore or enjoy the emotional reaction of distress or fear in someone. The morbid intellectual curiosity or desire to make someone suffer, as he or she has suffered, can be of great concern to the person’s family and could come to the attention of the police, depending on who the person chooses as a subject of his or her experiment. At present we have limited knowledge regarding what to do to change the behaviour and thinking of adolescents and adults in the malicious subgroup. Types of offences I have known people with Asperger’s syndrome who have committed offences ranging from being a public nuisance to homicide. The person’s strong moral code can lead to a confrontation and argument with people who are perceived as ‘immoral’, because they are wearing provocative clothing, for example dressing in the style of a particular sub-culture. A complaint is made to the police regard ing the person with Asperger’s syndrome, and the police decide on appropriate charges. Problems with access to a special interest can lead to charges of stealing to obtain money to buy items to add to the collection, or stealing the item of special interest itself. The charges tend to be for sexually inappropriate behaviour rather than sexually abusive or sexually violent behaviour (Ray, Marks and Bray-Garretson 2004). For example, the person with Asperger’s syndrome may not have had the usual social, sensual and sexual experiences of typical adolescents, and may develop sexually arousing fantasies involv ing objects, clothing, children or animals. A curiosity and confusion regarding sexuality can lead to the desire for more infor mation and the development of a solitary and clandestine special interest in pornogra phy. There can then be the assumption that the sexual behaviour seen in films and described in magazines is a script for a first date. Thus, I strongly advocate guidance in sexuality for adolescents and adults with Asperger’s syndrome, using the programs designed by specialists in Asperger’s syn drome (Henault 2005), and appropriate modifications for treatment programs for sexual offenders (Ray et al. It seems he felt by pointing out the skills of those with autistic personality disorder, he was emphasizing their potential advantage to the military, thus preventing such children from being taken from their parents and killed. When I met his daughter, Maria, in Zurich several years ago, I asked her if it is true that he made those comments on code breaking and she replied with an emphatic yes. I explained to Maria that his comments were remarkably astute and that during the second world war, British military intelligence had benefited from the characteristics of Asperger’s syndrome among the mathematicians who had contributed to cracking the German Enigma code.

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Eat foods containing fermentable carbohydrates at mealtimes only and in limited amounts diabetic shoes glipizide 10 mg lowest price. Chew sugarless or xylitol-containing gum or other xylitol-containing products diabetic diet recipes desserts order 10mg glipizide overnight delivery, four to diabetes test montreal purchase glipizide 10mg with mastercard fve times a day diabetes type 1 2 year old cheap 10mg glipizide free shipping, after eating. A “health commons approach” to1 oral health—where community-based, primary care safety net practices include medical, behavioral, social, public and oral health services—can enhance dental service capacity and increase access for low-income populations. Professionals working in these settings, including agencies such as Women, Infants and Children and Head Start, should provide anticipatory and other guidance to parents and integrate parent oral health curriculum into their client education services. Public health and community-based organization professionals are encouraged to: • Assist parents/caregivers in establishing a regular source of dental care (a “dental home”) for the child and for themselves. Brush the child’s teeth using a pea-sized (the size of a child’s pinky nail) amount of toothpaste, especially before bedtime. Children older than 2 should use fuoride toothpaste; children younger than 2 should use a smear of fuoride toothpaste on the brush only if they are at moderate to high risk of caries. Never put the child to bed with a bottle or sippy cup containing anything 17 other than water. The last thing to touch a child’s mouth at bedtime should be a 18 toothbrush or water. Limit foods containing fermentable carbohydrates—cookies, crackers, chips, dry cereals, candy (including fruit sugars)—to mealtimes only. Visit an oral health professional the with child by 12 months of age or when the frst tooth erupts. Part 1 Practice Guidelines for Providers of Care Perinatal Oral Health Practice Guidelines • Educate pregnant women and new parents about care that will improve their own oral health: Brush teeth twice daily with a fuoride toothpaste and foss daily, especially before bedtime. Avoid sodas and sugary beverages (including juices and sports drinks), especially between meals. Choose fresh fruit rather than fruit juice to meet the recommended daily fruit intake. There is suffcient, strong evidence to recommend appropriate oral health care for these groups of patients. These Perinatal* Oral Health Practice Guidelines are intended to assist health care practitioners in private, public and community-based settings in understanding the importance of providing oral health services to pregnant women and their children and making appropriate decisions regarding their care. The Guidelines are based on a review of current medical and dental literature related to perinatal oral health, and their development was guided by a group of national experts. Because these Guidelines do not represent a static standard of community practice and are established based on current scientifc evidence, the recommendations in this document should be reviewed regularly by medical and dental experts in the light of scientifc advances and improvement in available technology, approaches or products. Good oral health has the potential to improve the health and well-being of women during pregnancy,2 and contributes to improving the oral health of their children. Pregnancy and early childhood are particularly important times to access oral health care since the consequences of poor oral health can have a lifelong effect3—and because pregnancy is a “teachable moment” when women are receptive to changing behaviors that can beneft themselves and their children. However, oral health care in pregnancy is often avoided and misunderstood by dentists, physicians and pregnant women because of the lack of information or perceptions about 19 4 20 the safety and importance of dental treatment during pregnancy. Dental and obstetrical professionals who care for women during pregnancy need evidence-based and practical information concerning the risks and benefts of dental treatment to oral and overall health, and an understanding of the factors that affect a woman’s dental care used to support more effective practice behaviors. While evidence-based practice guidelines, such as those developed by the New York State Department of Health5 and other professional advisories, are evolving to support practitioners, many dentists withhold or delay treatment of pregnant patients because of a fear of injuring either the woman or the fetus. In addition to obstetricians, family physicians and other primary care providers play a pivotal role in preventing oral disease, especially among minority and underserved populations who * While the term “perinatal” generally refers to the period around childbirth. In its broadest sense of maternal and child health, “perinatal” could include time after and between pregnancies. Part 2 the Evidence-Based Science Introduction Perinatal Oral Health Practice Guidelines have limited access to dental services and poorer oral health status; and they in a unique position to fll gaps in access to care. Emerging data on important oral-systemic linkages9 suggest an increasing need for dental-medical collaboration and cross-training. In California, for example, one study found that in 2004 fewer than one in fve pregnant women enrolled in Medicaid received any dental services. An expert panel of medical and dental professionals was engaged to review the scientifc literature and, on the basis of evidence and professional consensus, derive practice guidelines. The committee was composed of professionals representing organizations such as the American Academy of Pediatrics, California Primary Care Association, California Nurse-Midwives Association, American Dental Association, American Association Part 2 the Evidence-Based Science Introduction Perinatal Oral Health Practice Guidelines of Public Health Dentistry, National Network for Oral Health Access, and American Academy of Pediatric Dentistry. Its role included helping to identify the expert panel, developing the agenda for the consensus conference and reviewing, and giving feedback on the Guidelines during their development. The interdisciplinary expert panel was selected for their subject matter expertise in oral health and perinatal medicine and represented medical and dental specialties such as maternal-fetal medicine and periodontology. Panel members were charged with performing a literature search on the available science and presenting a summary of evidence-based studies that provided the framework for developing the Guidelines according to the following defnition of evidence-based decision making: practices and policies guided by documented scientifc evidence of effectiveness, particular to and accepted by the specifc feld of practice. The experts were charged with identifying existing interventions, practices and policies; assessing issues of concern; and developing recommendations. Consensus Conference the expert panel made their presentations at a two-day consensus conference held in Sacramento, Calif. In addition to the Advisory Committee members, the conference was also attended on the frst day by representatives of about 50 multidisciplinary stakeholder groups involved in maternal and child health. Many of these representatives—from such organizations as the California Department of Public Health’s Maternal, Child and Adolescent Health program; Kaiser Permanente; and the California Primary Care Association Dental Director’s Network—have direct 21 involvement in the care of pregnant women and young children. The engagement 22 of stakeholders early in the process encouraged buy-in and gave these groups the opportunity to provide feedback about the practicality of implementing the Guidelines as they were being developed. Following the research presentations on the frst day, the panelists and Advisory Committee on the second day reviewed numerous comments submitted from the audience the previous day and identifed common themes, unanswered questions, key messages and recommendations. Major fndings pertaining to each topical area were then re-reviewed relative to specifc clinical Guidelines for prenatal, oral health and child care professionals to identify areas of agreement as well as ambiguity. The group relied on expert consensus when controlled studies were not available or conclusive to address specifc issues and concerns. Part 2 the Evidence-Based Science Introduction Perinatal Oral Health Practice Guidelines the documentation and proceedings from this conference were summarized and supplementary material added to create these Guidelines, and several drafts were reviewed by the expert panel and Advisory Committee. Prior to dissemination, the fnal draft was revised to refect additional feedback from “reality testing” focus groups with local dentists and physicians from private, public and community-based practices that provided valuable feedback about their content, utility and prospective acceptance, as well as suggestions for dissemination. The Guidelines are organized around key issues addressed during the consensus conference to refect a patient-centered model of care—a model that takes into account the various factors that infuence a woman’s individual needs, personal circumstances, and ability to access services, in addition to advice and counsel from health professionals. Perinatal Oral Health Consensus Statement the key consensus statement developed by the expert panel and Advisory Committee conference participants is as follows: Perinatal Oral Health Consensus Statement Prevention, diagnosis and treatment of oral diseases, including needed dental radiographs and use of local anesthesia, are highly benefcial and can be undertaken during pregnancy with no additional fetal or maternal risk when compared to the risk of not providing care. Good oral health and control of oral disease protects a woman’s health and quality of life and has the potential to reduce the transmission of pathogenic bacteria from mothers to their children. A woman’s preconception as well as pregnancy experience not only infuences her own oral health status but also may increase her risk of other diseases. Health care professionals providing preconception care, including primary and general women’s health care, between pregnancies should be educated to recognize the relationship between oral health and pregnancy, and maternal oral health status and future caries risk during early childhood. Maintaining good oral health during pregnancy can be critical to the overall health of both pregnant women and their infants. As part of routine prenatal care, pregnant women should be referred to oral health professionals for examinations and any needed preventive care or dental treatment. Despite clear links between oral and overall general health, oral health is not accorded the same importance in health care policy as is general health. While oral health should be an integral part of comprehensive care for pregnant women, variations in oral health practice patterns refect the fact that oral health screening and referral are not routinely included in prenatal care. The most critical periods of fetal development occur in the earliest weeks following conception, before many women even know they are pregnant. Because at least one-third of pregnancies are estimated to be unplanned,24 women frequently conceive while experiencing less than optimal health. Poor periodontal health is associated with chronic conditions such as diabetes, cardiovascular disease and some respiratory diseases. For women with diabetes diagnosed prior to pregnancy, for example, oral health is essential because acute and chronic infections make control of diabetes more diffcult. Rates of congenital anomalies increase as the degree of uncontrolled diabetes increases. Ongoing control of diabetes during pregnancy further decreases the risk of adverse pregnancy outcomes such as preeclampsia and large-for-gestational-age newborns. Some studies suggest it may also reduce the risk of oral congenital defects such as cleft lip, cleft palate and cleft lip with cleft palate. As part of routine care for pregnant patients and all women of childbearing age, dental professionals should remember to ask women if they take folic acid (most commonly in multivitamin supplements) and recommend it if they do not. First, women may self medicate with potentially unsafe over-the-counter medications such as aspirin to control pain.

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