Tuberculosis: Occupational risk among dental healthcare workers and risk for infection among dental patients. A meta-narrative review

Objectives: Tuberculosis transmission among healthcare workers (HCWs) and patients is due to the level of Mycobacterium tuberculosis (MT) circulation in the community and in the healthcare settings where HCWs are active. In contrast, most papers about dentistry reportthat dental HCWs (DHCWs) and patients are at relatively high risk, mainly based on tuberculosis case series that occurred in the 80’s–90’s. This meta-narrative review was designed to evaluate the tuberculosis risk in dentistry accounting for the historical-geographical contexts. Data: All available studies reporting data on MT infection (active/latent tuberculosis, tuberculin skin test) among patients and DHCWs. Sources: PubMed, Scopus, GOOGLE Scholar. Keywords: MT/tuberculosis and dentistry/dentist/dental/dent*. Results: 238 of the 351 titles were excluded because did not concern dental healthcare providing, 94 papers were excluded because they did not provide original data. Thirteen studies on occupational risk, nine on transmission to patients remained. Some, often non-confirmed, cases of MT infection among patients were reported in specific historical-geographical contexts where MT was endemic. The risk of active pulmonary tuberculosis transmission from infected DHCWs to patients is minimal today, provided that the basic infection control guidelines are applied. The development of active tuberculosis among DHCWs is occasional and is associable to MT circulation rather than dental healthcare providing. Clinical significance: Tuberculosis transmission in dental healthcare settings was due to the lack of basic infection control measures, while the risk is acceptable (i.e., similar to the general population) nowadays. Therefore, tuberculosis transmission can be safely prevented wearing gloves and surgical mask and providing regular air changes in the operative and non-operative dental healthcare settings. Precautionary Principle-based measures are implementable when patients with active pulmonary tuberculosis are routinely treated.