While most dental offices have infection control protocols in place to reduce transmission of disease from patient to patient, staff to patient, and patient to staff, most are not prepared against tuberculosis (TB) transmission. TB is a bacterial infection found in many areas of the world outside the United States. It is airborne, transmitted by coughing, sneezing, speaking, and singing. TB can spread in the dental office during aerosol-producing procedures since standard surgical masks don’t filter out the particles, nor are offices designed with airborne infection control protocols similar to hospitals. When dental patients are suspected of having a TB infection, they should be isolated from others and wear a mask. When infection is certain, patients should be referred to their physician. Clearance for treatment is determined by 3 negative sputum tests. If the patient presents with an emergency and exposing staff or patients is likely, the patient can be referred to a facility specifically designed with ventilation and respirators for airborne infection control. When an alternate facility is not available, the primary healthcare provider should be consulted. Local health departments can be contacted for referrals when necessary. TB symptoms include coughing, night sweats, weight loss, feeling sick, and fever. They are similar to other disease symptoms. However, with TB the cough does not go away and may contain blood. Patients indicating contact with infected persons or coming from a region where TB is endemic are at increased risk. The number of TB cases overall is declining, with 13,760 cases reported in 2006. The percentage decrease from 1993 to 2000 was 7.3%; in 2006 the number of cases dropped 3.2%. Foreign-born individuals from Africa and Asia have the highest rate of infection, with South and Central America at elevated rates. All employees in dental practices should test for TB exposure when they are hired. While there are different tests available, the CDC recommends the Mantoux skin test. Staff should be trained in recognition of TB and instructed on how to refer that patient for further treatment.
(Source: Dimensions of Dental Hygiene, September 2007)
