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Infection Control · patient case question

How should the urgent treatment be managed?

Patient case: Newly Diagnosed Tuberculosis

demo: 41-year-old male

chief: Presents to urgent dental care with severe pain from tooth #14.

history: Diagnosed with active pulmonary tuberculosis one week ago; started on therapy 3 days ago. Productive cough, night sweats, weight loss.

meds: Isoniazid, rifampin, pyrazinamide, ethambutol

findings: Tooth #14 with pulp necrosis and symptomatic apical periodontitis. Also requests a routine cleaning.

  1. Treat in an isolation room with airborne precautions, wearing an N95 respirator
  2. Treat only after 6 months of therapy is complete
  3. Treat in an open bay wearing a standard surgical mask
  4. Refer to the emergency department for extraction under general anesthesia
Show answer and explanation

Correct answer: A. Treat in an isolation room with airborne precautions, wearing an N95 respirator

  • A. Correct. Active TB is transmitted by airborne droplet nuclei. Urgent care requires an airborne infection isolation room and an N95 respirator — a surgical mask does not filter droplet nuclei.
  • B. Deferring urgent care for 6 months is not acceptable for a patient in acute pain.
  • C. A surgical mask protects against splatter, not the 1–5 micron droplet nuclei that carry M. tuberculosis.
  • D. Referral does not remove the airborne risk; it merely relocates it, and the pain is dentally manageable.

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