Infection Control

The CDC recommends the following for reducing the risk of TB transmission in the dental office, depending on the facility's level of risk:

"In general, the symptoms for which patients seek treatment in a dental care setting are not likely to be caused by infectious TB. Unless a patient requiring dental care coincidentally has TB, it is unlikely that infections TB will be encountered in the dental setting. Furthermore, generation of droplet nuclei containing M. tuberculosis during dental procedures has not been demonstrated. Therefore, the risk for transmission of M. tuberculosis in most dental settings is probably quite low. Nevertheless, during dental procedures, patients and dental workers share the same air for varying periods of time. Coughing may be stimulated occasionally by oral manipulations, although no specific dental procedures have been classified as "cough inducing". In some instances, the population served by a dental care facility, or the HCW's in the facility, may be at relatively high risk for TB. Because the potential exists for transmission of M. tuberculosis in dental settings, the following recommendations should be followed:

A risk assessment [Section II.B] should be done periodically, and TB infection-control policies for each dental setting should be based on the risk assessment. The policies should include provisions for detection and referral of patients who may have undiagnosed active TB, management of patients with active TB relative to provision of urgent dental care; and employer-sponsored HCW education, counseling and screening.
While taking patients' initial medical histories and at periodic updates, dental HCW's should routinely ask all patients whether they have a history of TB and symptoms suggestive of TB.
Patients with a medical history or symptoms suggestive of undiagnosed active TB should be referred promptly for medical evaluation of possible infectiousness. Such patients should not remain in the dental care facility any longer than required to arrange a referral. While in the dental care facility, they should wear surgical masks and should be instructed to cover their mouths and noses when coughing or sneezing.
Elective dental treatment should be deferred until a physician confirms that the patient does not have infectious TB. If the patient is diagnosed as having active TB, elective dental treatment should be deferred until the patient until the patient is no longer infectious.
If urgent dental care must be provided for a patient who has, or is strongly suspected of having, infectious TB, such care should be provided in facilities that can provide TB isolation (Sections II.E and G) Dental HCWs should use respiratory protection while performing procedures on such patient.
Any dental HCW who has a persistent cough (i.e., a cough lasting 3 weeks), especially in the presence of other signs or symptoms compatible with active TB e.g., weight loss, night sweats, bloody sputum, anorexia, and fever), should be evaluated promptly for TB. The HCW should not return to the workplace until a diagnosis of TB has been excluded or until the HCW is noninfectious.
In dental-care facilities that provide care to populations at high risk for active TB, it may be appropriate to use engineering controls similar to those used in general-use areas (e.g., waiting rooms) of medical facilities that have a similar risk profile."