Infection Control · patient case question

The patient also wants his routine prophylaxis appointment. What is the correct decision?

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.

Proceed only if the patient wears a surgical mask during treatment
Proceed with the cleaning using an ultrasonic scaler in the isolation room
Defer elective treatment until the disease is no longer in the acute infectious stage
Proceed with hand instrumentation only, in a standard operatory

Show answer and explanation

Correct answer: C. Defer elective treatment until the disease is no longer in the acute infectious stage

A. A patient cannot wear a mask during dental treatment, and the source control would be inadequate anyway.
B. Ultrasonics generate large volumes of aerosol and are precisely what should be avoided in an infectious TB patient.
C. Correct. Elective care is postponed until the patient is no longer infectious — typically documented by clinical improvement and negative sputum smears after adequate therapy.
D. Elective care is postponed regardless of instrumentation, because the exposure risk is not justified by an elective benefit.