Medical ConditionsCardiac & respiratory: Tuberculosis
Medical ConditionsCardiac & respiratory: Tuberculosis
Tuberculosis
Overview
Board takeaway: Defer elective care for suspected or confirmed infectious tuberculosis; urgent dental care requires a facility with airborne infection isolation.
How do latent tuberculosis infection and active tuberculosis disease differ?
Latent infection: organisms are present without evidence of active disease; the person has no TB symptoms and cannot spread TB to others.
Active disease: organisms cause illness; pulmonary or laryngeal disease may be infectious. Spread occurs through shared air when an infectious person coughs, speaks, or sings. A positive skin or blood test requires medical evaluation to distinguish these states; a negative test does not exclude disease when suspicion is substantial.
Which symptoms raise concern for tuberculosis?
Persistent cough, fever, night sweats, weight loss or failure to thrive, fatigue, chest symptoms, or hemoptysis warrant medical assessment. Children may have extrapulmonary disease, including cervical lymphadenopathy or central nervous system disease. Young age and immune compromise increase progression risk.
What oral findings can occur in tuberculosis?
Oral disease is uncommon. Persistent ulcers, nodules, indurated lesions, cervical nodes, or jaw lesions can occur, but none establishes TB clinically. An unexplained lesion requires an appropriate diagnostic workup and consideration of other infections or malignancy.
What should the dental team do when infectious tuberculosis is suspected?
- Stop or defer nonurgent care: minimize time sharing the dental air space.
- Use source control: the patient wears a surgical or procedure mask when possible and follows cough etiquette.
- Arrange prompt medical evaluation: establish possible infectiousness and treatment status.
- Refer urgent dental needs: use a setting with airborne infection isolation and appropriate respiratory protection, at least an N95 respirator for staff. A routine operatory plus an N95 is insufficient.
- Resume elective care: after medical confirmation that the patient is not infectious.
How do tuberculosis treatment and medications affect dental planning?
Medical treatment uses a regimen selected for disease type and susceptibility. Review hepatotoxicity and medication interactions, including rifamycin effects on other drugs. Latent infection alone does not require airborne isolation or dental deferral once active disease has been excluded.