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Tuberculosis

My Dental Patient is a TB Patient

03/02/2009

Question:

I`m a Dental Asstistant. I took full mouth x-rays of a patient before checking health history. This patient has checked off having TB. Is this something I need to be concerned with? If so, what do I do?

Answer:

When a patient checks TB on a health questionnaire, I suggest you further discuss whether the TB is active (and potentially contagious) or latent before proceeding with any other care. As a health-care worker, you are supposed to receive training about tuberculosis that would allow you to assess your risk of being infected with TB as result of patient care.

The following is quoted from the section entitled "Dental-Care Settings" from the CDC "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005," and it should give you some food for thought. You can also call your county health department for information about TB in your area.

"The generation of droplet nuclei containing M. tuberculosis as a result of dental procedures has not been demonstrated. Nonetheless, oral manipulations during dental procedures could stimulate coughing and dispersal of infectious particles. Patients and dental HCWs share the same air space for varying periods, which contributes to the potential for transmission of M. tuberculosis in dental settings. For example, during primarily routine dental procedures in a dental setting, MDR TB might have been transmitted between two dental workers.

"To prevent the transmission of M. tuberculosis in dental-care settings, certain recommendations should be followed. Infection control policies for each dental health-care setting should be developed, based on the community TB risk, and should be reviewed annually, if possible. The policies should include appropriate screening for LTBI and TB disease for dental HCWs, education on the risk for transmission to the dental HCWs, and provisions for detection and management of patients who have suspected or confirmed TB disease.

"When taking a patient's initial medical history and at periodic updates, dental HCWs should routinely document whether the patient has symptoms or signs of TB disease. If urgent dental care must be provided for a patient who has suspected or confirmed infectious TB disease, dental care should be provided in a setting that meets the requirements for an Airborne Infection Isolation (AII) room. Respiratory protection (at least N95 disposable respirator) should be used while performing procedures on such patients.

"In dental health-care settings that routinely provide care to populations at high risk for TB disease, using engineering controls (e.g., portable HEPA units) similar to those used in waiting rooms or clinic areas of health-care settings with a comparable community-risk profile might be beneficial.

"During clinical assessment and evaluation, a patient with suspected or confirmed TB disease should be instructed to observe strict respiratory hygiene and cough etiquette procedures. The patient should also wear a surgical or procedure mask, if possible. Non-urgent dental treatment should be postponed, and these patients should be promptly referred to an appropriate medical setting for evaluation of possible infectiousness. In addition, these patients should be kept in the dental health-care setting no longer than required to arrange a referral."

For more information:

Go to the Tuberculosis health topic, where you can:

Response by:

Lisa A Haglund, MD Lisa A Haglund, MD
Associate Professor of Clinical Medicine
College of Medicine
University of Cincinnati