Prof. Graziani Filippo
Full Professor in Periodontology, University of Pisa

Prof. Gabriele Mario
Full Professor in Oral Surgery, University of Pisa

Prof. Giuca Maria Rita
Full Professor in Pediatric Dentistry, University of Pisa

Prof. Barone Antonio
Associate Professor, University of Pisa

Dr. Izzetti Rossana
Research Fellow, University of Pisa

Dr. Lardani Lisa
Research Fellow, University of Pisa

Ms. Biancarini Maria Lucrezia
University of Pisa

Dr. Cairoli Jean Louis
Private Practice in Como

Dr. Gennai Stefano
Research Fellow, University of Pisa

Dr. Nisi Marco
Assistant Professor, University of Pisa

The rapid and sudden outbreak of the COVID-19 pandemic brought us to reconsider many of the solid certainties that we have been accustomed as health care practitioners. The nature of our profession allows us to deal with the unknown on a regular basis. It is nonetheless a unique feature, and most probably never existed before, the swift change of paradigms that we are witnessing daily during these unforgettable months.

Our group tried from the very first moment to deal with possible suggestions for clinical practice during these dire times. Our results have ultimately produced a sort of checklist that we believe it is our duty to share with colleagues worldwide. However, some caveats are important, and the following precautions need to be adopted:

Our profession is risky due to the intimate closeness with unmasked patients. Thus, any professional must accept that there is a risk that cannot be nullified.

In this book we do not describe guidelines nor recommendations, but a sum of suggestions deriving from the available knowledge and the clinical experience of the authors. Current evidence is still lacking proper randomized clinical trials.

Please follow your government and ministry of health recommendations. These suggestions should not in anyway interfere with the former.

The suggestions may change swiftly as this is the nature of the ongoing clinical knowledge.

Normally, in reading such comments we would be tempted to dismiss the book or, worse, being hit by an attack of grey pessimism. However, we must remind the reader that in no time in history the world has been better prepared to face a global challenge like this one. These are complex and difficult days, but soon humanity will prove its value as treatments and vaccines will arrive at unknown speed for the contemporary, now former, medical science. We are facing history and we have no doubt that the medical and the dental community are ready for that.

Filippo Graziani
Rossana Izzetti
Lisa Lardani
Maria Lucrezia Biancarini
Mario Gabriele

TABLE OF CONTENTS

AUTHORS LIST

Preamble

Table of Contents

The Checklist and the procedures

Coronaviruses and SARS-CoV-2

Coronaviruses

SARS-COV-2

Transmission routes

Epidemiology

Clinical features

Airborne generated procedures: professional risk in Dentistry

Bioaerosols and types of transmission

Background

Considerations on dental practice

Suggestions

Conclusions

Aerosol generating procedures

Background

Suggestions

Conclusions

Professional hazard by SARS-CoV-2

Background

Suggestions

Conclusions

PHASE I: Pre-triage

Patient triage

Patient risk profile

Background

Objectives

Suggestions

Conclusions

ACTION 1: PHONE TRIAGE

Background

Objectives

Suggestions

Conclusions

ACTION 2: AGENDA SET-UP

Background

Objectives

Suggestions

Conclusions

ACTION 3: SELF-CERTIFICATION

Background

Objectives

Suggestions

Conclusions

PHASE II: Upon patient arrival

Background

Suggestions

ACTION 4: PRACTICE SETUP

Reception

Reception desk set-up

Waiting room set-up

ACTION 5: PATIENTARRIVAL AT THE PRACTICE

Patient reception

In-office triage

Accompanying person

ACTION 6: PREPARATION OF THE CLINICAL AREA

ACTION 7: CLINICAL STAFF PROTECTION

Wearing gloves

Wearing gown

Wearing cap

Wearing mask

Wearing goggles and face shield

Conclusion

PHASE III: Treatment

Background

ACTION 8: PATIENT PREPARATION

ACTION 9: TREATMENT MANAGEMENT

Conclusion

PHASE IV: Post-treatment management

ACTION 10: PATIENT EXITING

Background

Suggestions

Conclusion

ACTION 11: CLINICAL AREA SANITIZATION

Instruments and materials management

Background

Suggestions

Conclusion

Ventilation

Background

Suggestions

Conclusions

Surfaces disinfection

Background

Suggestions

Conclusions

ACTION 12: PPE REMOVAL

Background

Suggestions

Conclusions

Useful links