A patient with tuberculosis may be in need of urgent dental treatment. Patients infected with M tuberculosis occasionally seek urgent dental treatment at outpatient dental settings. Understanding the pathogenesis of the development of TB will help DHCP determine how to manage such patients.

These small particle bacteria (1 to 5 microns) may be carried as an airborne infective droplet that can remain suspended in air for hours. Infected persons can produce these droplets with seemingly innocent actions like sneezing, coughing, speaking or singing. Surgical masks do not prevent inhalation of M tuberculosis. Once these droplets are inhaled, they travel to the alveoli of the lungs. The immune response usually prevents further spread within 2 to 12 weeks. While spread has been controlled, these bacteria can remain alive in the lungs (latent TB). Patients with latent TB will be reactive to tuberculin skin test (TST) but will have no symptoms and are not infectious. Persons with latent TB may have active disease later in life if the latent infection is not treated. The risk of exposure of the DHCP is probably low except if the community being served has a relatively high risk for exposure.

M tuberculosis

General Recommendations
• Educate all DHCP regarding the recognition of signs, symptoms and transmission of TB.
• Conduct a baseline TST, preferably by using a two-step test, for all DHCP who might have contact with persons with suspected or confirmed active TB, regardless of the risk classification of the setting.
• Assess each patient for a history of TB as well as symptoms indicative of TB and document on the medical history form. Follow DOH recommendations for 1) developing, maintaining and implementing a written TB infection-control plan; 2) managing a patient with suspected or active TB; 3) completing a community risk-assessment to guide employee TSTs and follow-up; and 4) managing DHCP with TB disease.

For patients known or suspected to have active TB:
• Evaluate the patient away from other patients and DHCP. When not being evaluated, the patient should wear a surgical mask or be instructed to cover mouth and nose when coughing or sneezing.
• Defer elective dental treatment until the patient is noninfectious.
• Refer patients requiring urgent dental treatment to a previously identified facility with TB engineering controls and a respiratory protection program.