A patient with ACTIVE, untreated pulmonary tuberculosis presents with pain and swelling. What is the most appropriate management in a general dental office?

Correct answer: A. Defer elective care and refer for urgent treatment in a facility with airborne infection isolation

• A. CORRECT. Mycobacterium tuberculosis is transmitted by AIRBORNE droplet nuclei that remain suspended for hours — a typical dental operatory cannot contain it. A patient with ACTIVE infectious TB should have ELECTIVE dental care DEFERRED until they are rendered non-infectious by therapy. When treatment is genuinely URGENT, it must be provided in a facility with an AIRBORNE INFECTION ISOLATION ROOM (negative pressure, 6–12 air changes per hour, HEPA filtration or exhaust to the outside), with staff wearing fit-tested N95 or higher respirators. Refer; do not improvise.
• B. Blanket refusal is not appropriate: it abandons a patient in pain. The correct action is to REFER to an appropriate facility so that urgent care is actually delivered.
• C. Standard precautions cover bloodborne and contact routes. Airborne pathogens — tuberculosis, measles, varicella — require an additional tier of precautions.
• D. Standard precautions do NOT interrupt airborne transmission. TB requires AIRBORNE precautions in addition — an isolation room and respiratory protection, not merely a surgical mask.

Note: In that setting the defensible answer is defer and refer. Patients on effective therapy typically become non-infectious after roughly 2–3 weeks with clinical improvement and negative sputum smears; obtain clearance from the treating physician before proceeding.