**10. Conclusion**

134 Complementary Pediatrics

When facing bites by Coral Snakes, the FDA extended the expiration date on the only product available in the United States to treat these envenomations. Wyeth's *Micrurus fulvius* Antivenin is no longer in production and there has been a need to obtain antivenoms produced in other countries (eg, Brazil, Costa Rica) for non-North American coral snakes. Mexico shares snake distribution with the United States. This country produces antivenom that is likely effective for coral snake bites in the United States. In the absence of such antivenom care must be entirely supportive. (R. L Norris, n.d.). Wound care should include irrigation, cleansing and dressings. Is convenient to consider tetanus prophylaxis and

Compartmental syndrome is a limb threatening complication and it is considered a medical emergency that should be managed with fasciotomies. Fasciotomies are indicated in patients with signs and symptoms related to the syndrome, such as, pain to passive mobilization, hipostesia, weakness and elevated compartmental pressure, measured every hour with more than 30 mmHg regardless of elevation of the extremity and the administration of the

Snake bites are considered occupational accidents involving farmers, workers in plantations, sheepherders and fishermen (Alirol, Sharma, Bawaskar, Kuch, & François Chappuis, 2010). The Statistical Yearbook of the Méxican Ministry of Health (SSA) in the chapter on accidents and poisoning in the section of hospital morbidity does not appear to report cases of snakebites in the years 1995 to 2000. Clearly there is an underreporting of such injuries. This assertion is based on the IMSS 1994-1998 reported 2 620 cases with 23 deaths (0.8%). (Madrazo-Navarro M, Zarate-Aguilar A, 1998). Although in normal conditions victims are adults, we must take into account that children perform these activities in many third world countries. In performing these activities, people should wear appropriate clothing (heavy pants, rubber boots) and it could be helpful to limit activities that involve staying in areas with tall grass to hours with sunlight. Most of the times this is impossible, and in these cases is important to educate the population about the appropriate pre-hospital management in case of a snake bite. They should know the fastest routes to reach the nearest hospital and take into account that children engaged in these activities are at greater risk of bites by snakes and that the severity of these lesions is greater, even if they are exposed to the same

Open rooms with no windows or doors and some habits, such as sleeping on the ground exposes people to night snake attack (Alirol et al., 2010) and these practices must be eradicated whenever it is possible. Since the snake bites are more common in the legs, feet, to be more precise, the mere fact of having children wear shoes dramatically reduces the incidence of such bites, as well as keeping children away from sites where snakes may hide, especially in the evenings and early hours of the morning in summer and autumn seasons.

There is very vague knowledge about the procedures to be followed when someone is attacked by a snake, below we present some guidelines that contrary to popular belief and

analgesia in case of need.

antivenin. (Walter, Bilden, & Gibly, 1999)

amount of venom as an adult.

(Hon, Kwok, & Leung, 2004)

misinformation should not be performed:

**8. Complications** 

**9. Prevention** 

Snakebites are not an infectious disease, they do not have an epidemic potential and snakes themselves are not vectors that carry important diseases throughout the world. Nonetheless, the mortality caused by these attacks is greater than the mortality attributed to other diseases such as dengue hemorrhagic fever, cholera and Chaga's disease. At least 100 000 people die as a result of snake bites each year, and around three times as many amputations and other permanent disabilities are caused by snakebites annually and agricultural workers and children are the most affected (World Health Organization, n.d.). It is important to be familiar with first aid procedures as well as proper treatment in a hospital environment in order to decrease deaths and prevent complications and sequels derived from this very important health issue.

Science has made tremendous progress with regard to drug treatment for children and adults who have been bitten by snakes. Successful treatment will always depend on the speed with which you begin handling the victim from the outpatient level, as well as the availability of the drugs for proper treatment once the patient enters the hospital. Keep in mind that treatment recommendations published in 1999 could represent insufficient dosages and it is necessary an accurate clinical assessment to provide an effective therapy.

#### **11. References**


**1. Introduction** 

**2. Dental caries development** 

**2.1 Etiology of dental caries** 

**8** 

*Turkey* 

**What is the Role of** 

*Uludag University, School of Medicine, Consultation Unit of Oral Diseases,* 

Cigdem Elbek Cubukcu

**Pediatricians on Oral Health?** 

Good oral health and dentition is important for efficient mastication, speaking and cosmetically for smiling. If left untreated, dental pathologies can lead to pain and infection, reduced growth and development, speech disorders, and high treatment costs. Chronic infection around one or more teeth can result in damage to localized structures, such as the developing permanent teeth. Children who are medically compromised (such as being immunocompromised from a disease and/or therapy) are at increased risk of developing systemic complications from dental infections which can be fatal. Therefore, the author focuses on the role of the general pediatrician in promoting the importance of good oral health for all children and in particular those children receiving cancer therapy. Etiology, assessment, and prevention of dental caries and oral mucositis are presented, evidence based where available.

Dental caries has historically been considered one of the most important global oral health burdens. It is still a major health problem in both developing and developed countries. 60-90 % of school-aged children are affected by the disease (Petersen, 2003). At present, the distribution and severity of dental caries vary in different parts of the world and within the same region or country. In permanent dentition, when dental caries experience is expressed as Significant Caries Index (SiC), the determined values are relatively high both for America region (SiC = 4.8) and the European region (SiC = 5.3) whereas the experience is lower in most African countries (SiC = 3.4) (World Health Organization [WHO], 2011). In developing countries, the prevalence rates of dental caries and its experience are now tending to increase probably due to the increasing consumption of sugars and inadequate exposure to fluorides. Conversely, a decline in caries has been observed in most developed countries as a result of a number of public health measures, including effective use of fluorides, together with changing living conditions, lifestyles and improved self-care practices. However, it must be emphasized that *dental caries as a disease of children has not been eradicated, but only controlled to a certain degree.* 

Dental caries is a process that may take place on any tooth surface in the oral cavity where dental plaque (biofilm) is allowed to develop over a period of time. Plaque formation is a

Government of Canada, A. & A.-F. C. (n.d.). Integrated Taxonomic Information System (ITIS);Biological Observations, Specimens and Collections (BiOSC) Gateway. Retrieved July 29, 2011, from

 http://www.cbif.gc.ca/pls/itisca/next?v\_tsn=563895&taxa=&p\_format=&p\_ifx=c bif&p\_lang=

