Active Tuberculosis and the Denial of Dental Treatment

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nguyenkimphat

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I was told that dentist can reject patients who had active tuberculosis. Is this true? Why or why not?

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It is true, if the patient has an active TB infection. A history of TB with no symptoms is a different story.

A person with active TB symptoms is infectious and is a real danger to everyone in the office. We produce aerosol sprays during our procedures and the tuberculosis bacilli could become airborne, causing the infection to spread. TB can be treated with drugs over the course of several months, after which time the patient is no longer infectious.
 
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It is true, if the patient has an active TB infection. A history of TB with no symptoms is a different story.

A person with active TB symptoms is infectious and is a real danger to everyone in the office. We produce aerosol sprays during our procedures and the tuberculosis bacilli could become airborne, causing the infection to spread. TB can be treated with drugs over the course of several months, after which time the patient is no longer infectious.

Thank you so much for your response. I was wondering - what is the case with patients who have HIV? I was told that dentist do not have the legal right to refuse treatment to HIV individuals. Is that true? Why or why not?
 
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HIV is not transmitted through aerosols. Active TB much more dangerous!
 
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Pretty Sure Active TB is a CDC notafiable disease.
 
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Thank you so much for your response. I was wondering - what is the case with patients who have HIV? I was told that dentist do not have the legal right to refuse treatment to HIV individuals. Is that true? Why or why not?

Active TB can be easily transmitted during a routine dental procedure, despite taking reasonable precautions, because it is transmissible through aerosols. You could possibly provide treatment if you suited up as if for Ebola, in a negative pressure room, etc. but the risk vs benefit just isn't there. Treat the TB, then the caries.

HIV can be transmitted if you have a significant exposure to the patient's bodily fluids through non-intact skin. Routine precautions should be adequate to prevent such an exposure. If your routine precautions are not adequate to protect you against bloodborne pathogens, you need to step up your practice! Most of the time when you are treating someone with HIV, HCV, or HBV, you aren't going to know it. Sometimes, the patient themselves won't even be aware. That is why universal precautions are universal. Assume everyone has HIV, and protect yourself and your patients based on that degree of caution. Pretending that you are safe if you just discriminate against patients that trust you enough to disclose their HIV status is not only unethical, it is extraordinarily foolish from an infectious disease standpoint.
 
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Active TB can be easily transmitted during a routine dental procedure, despite taking reasonable precautions, because it is transmissible through aerosols. You could possibly provide treatment if you suited up as if for Ebola, in a negative pressure room, etc. but the risk vs benefit just isn't there. Treat the TB, then the caries.

HIV can be transmitted if you have a significant exposure to the patient's bodily fluids through non-intact skin. Routine precautions should be adequate to prevent such an exposure. If your routine precautions are not adequate to protect you against bloodborne pathogens, you need to step up your practice! Most of the time when you are treating someone with HIV, HCV, or HBV, you aren't going to know it. Sometimes, the patient themselves won't even be aware. That is why universal precautions are universal. Assume everyone has HIV, and protect yourself and your patients based on that degree of caution. Pretending that you are safe if you just discriminate against patients that trust you enough to disclose their HIV status is not only unethical, it is extraordinarily foolish from an infectious disease standpoint.


Thank you so much @Promethean for responding :) I really appreciate it - I was wondering, what are the steps of universal precautions? Do they just include gloves, face mask, face shield, goggles, and gown and scrubs, and cavicide?

Do you know where I can find the steps to protecting myself using the universal precautions?
 
Universal precautions aka standard precautions just means that you treat all patients as if they are potentially infectious, and so avoid unguarded exposure to bodily fluids. There isn't a single recipe for what constitutes universal precautions for every scenario. If you are going to touch a patient's intact skin with your intact skin, gloves aren't even necessary so long as good hand hygiene is performed before and after. If you are going to perform an IV placement, you are breaking their skin and could be exposed to blood... gloves and possibly eye protection are prudent. If you are going to be drilling in their mouth and spraying a fine aerosol of saliva and possibly blood into the room then gloves, a face mask with attached shield or else goggles, and maybe some protection for your scrubs, such as a gown, would be called for.

As long as you vary the degree of protection you employ based upon the degree of risk involved in the patient contact, rather than assumptions about the infection status of the patient themselves, you are applying the same standards universally.

Here is the latest CDC guideline regarding precautions.

http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

WARNING: It is long, detailed, and generally intended as an ultimately authoritative resource rather than a quick rundown of the basics. Expect that it could take over an hour to read and absorb, if you had the stamina to get through it.
 
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Universal precautions aka standard precautions just means that you treat all patients as if they are potentially infectious, and so avoid unguarded exposure to bodily fluids. There isn't a single recipe for what constitutes universal precautions for every scenario. If you are going to touch a patient's intact skin with your intact skin, gloves aren't even necessary so long as good hand hygiene is performed before and after. If you are going to perform an IV placement, you are breaking their skin and could be exposed to blood... gloves and possibly eye protection are prudent. If you are going to be drilling in their mouth and spraying a fine aerosol of saliva and possibly blood into the room then gloves, a face mask with attached shield or else goggles, and maybe some protection for your scrubs, such as a gown, would be called for.

As long as you vary the degree of protection you employ based upon the degree of risk involved in the patient contact, rather than assumptions about the infection status of the patient themselves, you are applying the same standards universally.

Here is the latest CDC guideline regarding precautions.

http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

WARNING: It is long, detailed, and generally intended as an ultimately authoritative resource rather than a quick rundown of the basics. Expect that it could take over an hour to read and absorb, if you had the stamina to get through it.

Thank you @Promethean - your response is amazing :)
 
You're welcome!

I get bored. And I have much procrastinating to do. I could be completing any of a dozen tasks that must be done in the next week or I could be answering forum posts. Clearly, I have priorities!
 
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