Tuberculosis (TB) is one of the world’s deadliest diseases, according to the CDC. In fact, one quarter of the world’s population is infected with TB. It is the leading killer of people who are infected with HIV.

In 2017, the CDC observed the lowest case count on record with 9,105 cases in the United States. So, while TB is the world’s deadliest disease, it is hardly a blip on most dental professionals’ radar. Be that as it may, TB is still a concern as it is an infectious disease for which there is no vaccine.

For OSHA purposes, it is necessary for dental offices to update their TB Risk Assessment annually to determine the likelihood of exposure and the need for administrative, work practice, and engineering controls to address TB in the dental practice setting. To update the TB Risk Assessment, review your patient data to determine the number of TB patients your practice has treated within the past year. Also, be sure to reference statistical data for the state and county of your practice. A simple Google search for “TB Stats by County” for your state should provide the information you need.

If your practice is a moderate or high risk for exposure to TB, then you must implement appropriate safeguards to protect employees from exposure. It is important to note two TB-related conditions exist: latent TB infection and TB disease.

Let’s break it down.

Latent TB infection: patients do not feel sick and do not have any symptoms. They are infected with the disease, but do not have TB. These patients are not infectious and cannot spread TB infection to others, so no special precautions are necessary.

A person with latent TB infection:

• Usually has a skin test or blood test result indicating TB infection
• Has a normal chest x-ray and a negative sputum test
• Has TB bacteria in his/her body that are alive, but inactive
• Does not feel sick
• Cannot spread TB bacteria to others
• Needs treatment for latent TB infection to prevent TB disease; however, if exposed and infected by a person with multidrug-resistant TB (MDR TB) or extensively drug-resistant TB (XDR TB), preventive treatment may not be an option

TB Disease: these patients ARE infectious and require medical intervention. Special precautions ARE necessary in the presence of these patients.

A person with TB disease:

• Usually has a skin test or blood test result indicating TB infection
• May have an abnormal chest x-ray, or positive sputum smear or culture
• Has active TB bacteria in his/her body
• Usually feels sick and may have symptoms such as coughing, fever, and weight loss
• May spread TB bacteria to others
• Needs treatment to treat TB disease

The general symptoms of TB disease include:

• Unexplained weight loss
• Loss of appetite
• Night sweats
• Fever
• Fatigue
• Chills

The symptoms of TB of the lungs include:

• Coughing for 3 weeks or longer
• Hemoptysis (coughing up blood)
• Chest pain

Other symptoms depend on the part of the body that is affected.

TB is an airborne disease meaning it is spread from person-to-person by air. Dental Health Care Workers (DHCW) must be provided adequate PPE, which in this case requires the use of respirator masks for which DHCW must be fit tested annually by a qualified occupational health specialist.

•      Does your office have a written TB exposure control plan?
•      Do you know what it says?
•      When was the TB Risk Assessment last updated?
•      Is your office a low, moderate, or high risk for exposure to TB?
•      What procedures and equipment does your office have to minimize employee exposure to TB?
•      What are the nearest dental facilities equipped and capable of caring for dental patients with infectious TB?
•      How will you and your colleagues react if someone presents to your office and you suspect they may have TB?

These are all questions to bring up at your next staff meeting. It is important your office have suitable protections in place. It is important your front desk staff are able to recognize the signs and symptoms of TB and to take appropriate action if/when someone suspected of having TB presents to your office. Appropriate recognition and response are key to minimizing exposure for everyone.

Paul Blart got it right when he said, “Safety never takes a holiday.” Please tell me I’m not the only fan of Paul Blart (Mall Cop)?

If your office does not have a TB Exposure Control Plan or you need help updating your Risk Assessment, you can reach us at 817-755-0035.

References:

•      CDC Data and Statistics, https://www.cdc.gov/tb/statistics/default.htm,
•      Fact Sheets: The Difference Between Latent TB Infection and TB Disease, https://www.cdc.gov/tb/publications/factsheets/general/ltbiandactivetb.htm

About the Author

A former Law Enforcement Officer/ Dental Board investigator, Duane Tinker is the CEO of Dental Compliance Specialists. Mr. Tinker provides compliance consulting, auditing and training services for dentists and Dental Service Organizations on compliance risks including OSHA, HIPAA, Dental Board rules/ regulations, state radiology rules, DEA and state drug regulations, and Medicaid. Mr. Tinker is a frequent speaker for dental societies and study clubs. He also hosts a podcast called Talking with the Toothcop. Mr. Tinker can be reached by calling (817) 755-0035 or through his company’s website DentalCompliance.com.