Hi everyone .. This is Case of acute irreversible pulpits. Did emergency root canal opening yesterday. Just want to share that this patient is suffering from multi drug resistant tuberculosis and is presently taking treatment including injectable. Patient is undergoing the treatment from past 8-9months and says that his tuberculosis is not infective for others which is something that I failed to understand. He said he never had positive sputum or no history of cough and fever . He only had chest pain which was later diagnosed as pleural effusion. Please suggest what should be done. Can I proceed with further treatment or not.



i guess people here are confusing you quite a bit.. that's because dentists are just told in theory that tuberculosis and thst too multi drug resistant is dangerous. Koch's is treatable, even MDR Koch's is eventually treated. patient is already on streptomycin and is under treatment since 9 months means his primary regime is completed and is in continuing phase of treatment. at this point his contagious state has ceased. pleural effusion is a complication caused by many reasons. his medical file would reveal better, don't just go by patient's words. also check with the physician. I don't think he would stop you from doing any treatment, be it RCT or extraction. and most importantly, do NOT prescribe any antibiotics, he is already on streptomycin and he also would be taking Rifampacin. that is gonna cover enough of oral n dental infections. if you are continuing with RCT please do NOT do in single sit as suggested by one of the dentists here

Thanks for your inputs Doc..

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Thanks for sharing. Advised examination of effusion, it's pulmonary koch's, advised AKT.

Please elaborate your answer sir.. M sorry to ask but have no clue about AKT..

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you can do treatment but take proper protection for you, your helping assistant and next patients. do proper sterilisation and dispose of the endo instruments. take advice from the physician who is treating him. post to proper crown cementation there might be food impaction between this tooth and second molar as it tilted mesially. already there is bone loss. give him instructions to maintain that area.

The Ideal time to work on TB patient is the Time when one is on AKT - Anti Koch's Therapy So, First Thing You can go ahead. Second thing, Have A talk and written ref of respective physician Third Thing Charge More and use all Disposable instruments, right from Mirror to Sealing. Fourth Do the case in Single seating to confirm minimum seatings and maximum output Fifth Explain everything in detail to patient before you start up with all above Never worry to leave patients if they are not paying for, or you may prefer yours and staffs' safety and earn less prophit.

MDR tuberculosis with pleural effusion . Risk is very high

Yes , Dr. I would like to briefly about TB, It's of 2 types - active or latent Active one has symptoms like -productive cough, fatigue,weight loss, night sweat , & positive tuberculin test. Latent one is not infectious & urgent care can be provided with precautions to minimise risk of droplet spread . Basically, it's an airborne infection transmitted by droplets So, precautions to be followed as per the standard guidelines are as- Consultation with physician should be done. - isolation should be provided when performing treatment in latent cases which are not infectious. -Please protect yourself &attending staff to wear fixed N95 respiratory mask . -Ask patient to wear surgical mask while coughing . Thanks!

Aspirations fm pleural effusion had been sent for AFB and culture and senditivity. According to that report pt was informed about mdr tuberculosis. Tuberculosis may spread fm chest to mandibular region . You should consult his physician and take consent .

hi dr.... as per me u can continue RCT ..... but what i hv a doubt as the xray says that there z a fracture at the furcation point & it seems lik distal root z separated.

Hi Dr. Suman.. I don't think there's any fracture at the furca and have clinically also checked so I can assure you that distal root is not separate. Thanks for your prompt reply.

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why are people focussing so much on usage of disposable instruments? tuberculosis is an air borne disease!! and if it is pulmonary tuberculosis then it will transmit only through aerosol dissipated in air by patient's respiration cough sneezing. the dental pulp shall not have any bacterium. and if at all it has, simple sterilisation of instruments will be enough

U can continue. Don't worry U can proceed with ur treatment Akt drugs use for tb but its leave on his family physician.

wear all protective coverings before treating this patient. sterlize your instruments regularly. TB is a contagenous disease which can spread even if the bacteria is in latent stage. I suggest you to go for extraction as the tooth is about 70% decayed. Please also consult the doctor who is treating him for TB.

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