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Special Issue "COVID-19: A Public Health Approach for Health Professionals"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 December 2020).

Special Issue Editors

Prof. Dr. Guglielmo Campus
E-Mail Website
Guest Editor
Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, 3012 Bern, Switzerland
Interests: community dentistry; oral epidemiology; public health; cariology; oral health prevention; pediatric dentistry
Special Issues and Collections in MDPI journals
Prof. Dr. Fabrizio Pregliasco
E-Mail Website
Guest Editor
Department of Biomedical Sciences for Health, University of Milan, IT-20142 Milan, Italy
Interests: public health; epidemiology; health management; infection prevention; environmental hygiene
Assoc. Prof. Dr. Maria Grazia Cagetti
E-Mail Website
Guest Editor
Department of Biomedical, Surgical and Dental Science, University of Milan, IT-20142 Milan, Italy
Interests: community dentistry; oral epidemiology; cariology; public health; oral health prevention; pediatric dentistry
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

In the COVID-19 pandemic, the scientific and medical world has been involved in intensive research to face the SARS-CoV-2 outbreak. The human-to-human transmission of this new virus is produced through airborne droplets and direct contact with contaminated surfaces. The risk of cross-infection in dentistry is recognized to be high, since splatters and aerosols produced through the use of handpieces during dental treatments may represent vehicles for bacteria, fungi, and virus diffusion. Data on the real risk of virus diffusion during dental procedures is urgent, since this issue has not yet been addressed in the literature for any type of virus.

The stability of SARS-CoV-2 in aerosols has been investigated in experimental conditions showing that airborne transmission of the coronavirus is plausible, since it can remain viable and infectious in aerosols for hours. This finding might be a relevant professional hazard for dental personnel and patients.

Several recommended strategies to control SARS-CoV-2 transmission in the dental enviroment during the pandemic are provided from International Dental Associations and local Authorities, including the use of appropriate personal protection devices and the reduction, as much as possible, of treatments that can produce droplets or aerosols. These strategies will impose changes to the dental routine and a reorganization of public and private dental care providers activities.

Papers addressing these topics are invited for this Special Issue, including protocol papers on the health professional risks of COVID-19, the epidemiology of SARS-CoV-2 diffusion in health professionals and dental personnel, risk assessment for patients and health workers, risk management, and intervention studies aiming to control the virus diffusion in the dental setting.

Prof. Guglielmo Campus
Prof. Fabrizio Pregliasco
Assoc. Prof. Maria Grazia Cagetti
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • COVID-19
  • SARS-CoV-2
  • Dental environment
  • Dental personnel
  • Patients
  • Cross-infection
  • Airborne
  • Aerosol
  • Public health
  • Dentistry

Published Papers (11 papers)

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Research

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Article
Influence of the COVID-19 Pandemic on Dental Emergency Admissions in an Urgent Dental Care Service in North Italy
by , , and
Int. J. Environ. Res. Public Health 2021, 18(4), 1812; https://doi.org/10.3390/ijerph18041812 - 12 Feb 2021
Cited by 1 | Viewed by 1004
Abstract
A retrospective study was performed to verify if the number of admissions for urgent dental care in the Urgent Dental Care Service of San Paolo Hospital in Milan (Italy) was directly related to the different phases of the COVID-19 pandemic. Different periods were [...] Read more.
A retrospective study was performed to verify if the number of admissions for urgent dental care in the Urgent Dental Care Service of San Paolo Hospital in Milan (Italy) was directly related to the different phases of the COVID-19 pandemic. Different periods were analyzed: 25 March–5 April 2019 (pre-COVID); 23 March–3 April 2020 (lockdown); 8 June–19 June 2020 (reopening); and November 9–November 20 (second wave). Raw data regarding admissions, diagnoses, and treatments were extracted. Descriptive and bivariate analyses were performed. The survey included 901 admissions, 285 in pre-COVID, 93 during lockdown, 353 in reopening, and 170 in the second wave. In each time period, statistically significant differences were found in the prevalence of each kind of diagnoses (χ2(3) = 20.33 p = 0.01 for endodontic emergencies, χ2(3) = 29.05 p < 0.01 for cellulitis/phlegmon, χ2(3) = 28.55 p < 0.01 for periodontal emergencies, Fisher’s Exact Test p < 0.01 for trauma, and χ2(3) = 59.94 p < 0.01 for all other kinds of diagnosis). A remarkable increase in consultations (+186.36%) and other treatments (+90.63%) occurred during reopening. Tooth extraction was the most frequently delivered treatment, but suffered the largest reduction during lockdown (−79.82%). The COVID-19 pandemic has highly affected dental activity in north Italy, underling the weaknesses of a private dental system in a pandemic scenario. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)
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Article
The Impact of SARS-CoV-2 Outbreak on the Polish Dental Community’s Standards of Care—A Six-Month Retrospective Survey-Based Study
Int. J. Environ. Res. Public Health 2021, 18(3), 1281; https://doi.org/10.3390/ijerph18031281 - 31 Jan 2021
Cited by 6 | Viewed by 1036
Abstract
Currently, SARS-CoV-2 is the primary pathogen worldwide, disrupting most of our everyday activities. The study aim was to evaluate its impact on the Polish dental community, standards of care, health, and welfare. Methods: A Google Forms survey was conducted among 303 dental practitioners. [...] Read more.
Currently, SARS-CoV-2 is the primary pathogen worldwide, disrupting most of our everyday activities. The study aim was to evaluate its impact on the Polish dental community, standards of care, health, and welfare. Methods: A Google Forms survey was conducted among 303 dental practitioners. Results: Of respondents, 54.93% curbed the number of patients in the last six months, 34.21% declared no changes, and 10.86% reported an increase; whereas 70.7% of the respondents reported a treatment price increase within the same period (27.96% and 1.32% reported no changes and a decrease, respectively). Of the respondents, 15.5% did not close their businesses during the first wave of the pandemic. Most declared 1 or 2 month break, 30.7% and 34.7%, respectively. Some reported 3, 4, or 5 month breaks (15.84%, 1.32%, and 0.99%, respectively), and only two respondents (0.66%) did not admit patients at all. Headache episodes were more frequent among female dentists before the pandemic; after the pandemic, headache frequency increased among both sexes. Temporomandibular disorders (TMDs) were more frequent among women (p = 0.017). Conclusions: Most Polish dentists followed SARS-CoV-2 recommendations and restricted their practices to admitting only patients with pain or incomplete treatment. Decreased sleep parameters, head, back, and neck pain, were observed. This situation may affect dental health conditions in Polish society over time. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)
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Article
Psychological Distress and Post-Traumatic Symptomatology among Dental Healthcare Workers in Russia: Results of a Pilot Study
Int. J. Environ. Res. Public Health 2021, 18(2), 708; https://doi.org/10.3390/ijerph18020708 - 15 Jan 2021
Cited by 5 | Viewed by 1212
Abstract
The spread of SARS-CoV-2 infection has increased the risk of mental health problems, including post-traumatic stress disorders (PTSD), and healthcare workers (HCWs) are at greater risk than other occupational groups. This observational cross-sectional study aimed to explore the symptoms of depression, anxiety, and [...] Read more.
The spread of SARS-CoV-2 infection has increased the risk of mental health problems, including post-traumatic stress disorders (PTSD), and healthcare workers (HCWs) are at greater risk than other occupational groups. This observational cross-sectional study aimed to explore the symptoms of depression, anxiety, and PTSD among dental HCWs in Russia during the coronavirus disease 2019 (COVID-19) pandemic. The survey was carried out among 128 dental HCWs from three dental clinics of Ekaterinburg, Russia. The mean age of the sample was 38.6 years. Depression, anxiety, and stress were assessed using the Depression Anxiety and Stress Scale-21 (DASS-21); PTSD was assessed using the PTSD Symptom Scale-Self-Report (PSS-SR); subjective distress was assessed using the Impact of Event Scale-Revised (IES-R). The results indicated that 20.3–24.2% HCWs had mild to extremely severe symptoms of psychological distress, and 7.1–29.7% had clinical symptoms of PTSD. No differences between females and males were revealed. HCWs working directly with patients had significantly higher levels of PTSD symptoms and the risk of PTSD development compared to those working indirectly, whereas older HCWs had significantly higher levels of both psychological distress and PTSD symptoms compared to younger HCWs. Thus, dental HCWs are at high risk for psychological distress and PTSD symptoms during the COVID-19 pandemic. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)
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Article
Risk Perception, Protective Behaviors, and General Anxiety during the Coronavirus Disease 2019 Pandemic among Affiliated Health Care Professionals in Taiwan: Comparisons with Frontline Health Care Professionals and the General Public
Int. J. Environ. Res. Public Health 2020, 17(24), 9329; https://doi.org/10.3390/ijerph17249329 - 13 Dec 2020
Cited by 3 | Viewed by 802
Abstract
This study aimed to compare risk perception, information sources, adoption of protective behaviors against coronavirus disease 2019 (COVID-19), and levels of general anxiety among affiliated health care professionals, frontline health care professionals, and the general public in Taiwan. We recruited participants via a [...] Read more.
This study aimed to compare risk perception, information sources, adoption of protective behaviors against coronavirus disease 2019 (COVID-19), and levels of general anxiety among affiliated health care professionals, frontline health care professionals, and the general public in Taiwan. We recruited participants via a Facebook advertisement. We determined the risk perception, information sources, adoption of protective behaviors against COVID-19, and levels of general anxiety among 1954 respondents. In total, 269 affiliated healthcare workers, 371 frontline healthcare workers, and 1314 members of the general public were recruited into this study. The results indicated that both affiliated and frontline health care professionals had a higher level of risk perception of COVID-19, and more adopted protective behaviors against COVID-19 than the general public. No significant differences in risk perception or the adoption of protective behaviors were identified between affiliated, and frontline, health care professionals. Affiliated health care professionals had a lower level of general anxiety than the general public, whereas frontline health care professionals exhibited no significant difference in level of general anxiety compared with the general public or affiliated health care professionals. As important members of COVID-19 treatment teams, the need for psychological and educational support in affiliated health care professionals should receive attention. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)
Article
COVID-19 in Switzerland and Liechtenstein: A Cross-Sectional Survey among Dentists’ Awareness, Protective Measures and Economic Effects
by , and
Int. J. Environ. Res. Public Health 2020, 17(23), 9051; https://doi.org/10.3390/ijerph17239051 - 04 Dec 2020
Cited by 7 | Viewed by 968
Abstract
The aim of this observational cross-sectional study was to gain information on the awareness; protective measures and economic effects of dentists in Switzerland during the global COVID-19 pandemic. All dentist were members of the Swiss Dental Association SSO from all over Switzerland—including all [...] Read more.
The aim of this observational cross-sectional study was to gain information on the awareness; protective measures and economic effects of dentists in Switzerland during the global COVID-19 pandemic. All dentist were members of the Swiss Dental Association SSO from all over Switzerland—including all Swiss cantons and Liechtenstein—and received a previously calibrated questionnaire as an ad hoc online version. The questionnaire was divided into four parts: personal data; precautionary measures; awareness; perception. In total, 1324 questionnaires were analyzed; the response rate was 30.59% (ntotal = 4328). Participants stated in less than 2% common symptoms/signs of COVID-19; of which only fatigue was statistically significant (p < 0.01). A small number of dentists reported a positive test (0.91%; n = 12) or having one or more symptoms (2.65%; n = 35) of COVID-19 during the pandemic; whereas only 6.71% (n = 87) of the participants reported having treated SARS-CoV-2 infected patients. High prevalence areas were only medium-large and large Swiss cantons (p < 0.01). Face filter (FFP2/FFP3) masks were used by about half of the dentists, while disposable visor was rarely used. The majority of dentists had to reduce the dental practice activity to a minimum of 0–10% (n = 923; 69.98%) due to the lockdown. This economic impact forced 1.4% (n = 18) to close their practice permanently or by the end of 2020 due to the economic situation. These results can be helpful to better prepare dental practices for future outbreaks of infection (e.g., prophylactic storage of additional protective measures), define the best strategy and organize the dental workforce. Political decision-makers should consider drastic economic effects when deciding on drastic measures such as “lockdown”, which can lead to practice closures and unemployment of dental staff after only a few weeks. This should be taken into account, especially with regard to possible financial assistance to severely impaired dental practices to maintain a high level of dental care. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)
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Article
Blockchain in Healthcare: Insights on COVID-19
Int. J. Environ. Res. Public Health 2020, 17(19), 7167; https://doi.org/10.3390/ijerph17197167 - 30 Sep 2020
Cited by 7 | Viewed by 2539
Abstract
The SARS-CoV2 pandemic has impacted risk management globally. Blockchain has been increasingly applied to healthcare management, as a strategic tool to strengthen operative protocols and to create the proper basis for an efficient and effective evidence-based decisional process. We aim to validate blockchain [...] Read more.
The SARS-CoV2 pandemic has impacted risk management globally. Blockchain has been increasingly applied to healthcare management, as a strategic tool to strengthen operative protocols and to create the proper basis for an efficient and effective evidence-based decisional process. We aim to validate blockchain in healthcare, and to suggest a trace-route for a COVID19-safe clinical practice. The use of blockchain in combination with artificial intelligence systems allows the creation of a generalizable predictive system that could contribute to the containment of pandemic risk on national territory. A SWOT analysis of the adoption of a blockchain-based prediction model in healthcare and SARS-CoV-2 infection has been carried out to underline opportunities and limits to its adoption. Blockchain could play a strategic role in future digital healthcare: specifically, it may work to improve COVID19-safe clinical practice. The main concepts, and particularly those related to clinical workflow, obtainable from different blockchain-based models have been reported here and critically discussed. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)
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Article
Assessment of Mental Health Factors among Health Professionals Depending on Their Contact with COVID-19 Patients
Int. J. Environ. Res. Public Health 2020, 17(16), 5849; https://doi.org/10.3390/ijerph17165849 - 12 Aug 2020
Cited by 17 | Viewed by 3260
Abstract
It seems that the medical personnel in contact with patients infected with SARS-CoV-2 are at an especially high risk of adverse psychological effects. Therefore, the aim of this study was to assess the mental health factors among healthcare workers by quantifying the severity [...] Read more.
It seems that the medical personnel in contact with patients infected with SARS-CoV-2 are at an especially high risk of adverse psychological effects. Therefore, the aim of this study was to assess the mental health factors among healthcare workers by quantifying the severity of anxiety, depression, and sleep disorders during the current SARS-CoV-2 pandemic, while taking into account coexisting diseases. The study involved 441 healthcare professionals including 206 healthcare workers at emergency wards, infectious wards, and intensive care units. The control group consisted of 235 healthcare workers working in wards other than those where individuals from the study group worked. Regression adjusted by age, gender, the occurrence of hypertension, diabetes mellitus, dyslipidemia, asthma, autoimmune diseases, and cigarette smoking showed the elevated risk of anxiety on the Generalized Anxiety Disorder (GAD-7) scale (OR = 1.934; p < 0.001), depression on the Patient Health Questionnaire (PHQ-9) scale (OR = 2.623; p < 0.001), and sleep disorders on the Insomnia Severity Index (ISI) scale (OR = 3.078; p < 0.001). Our study showed that healthcare workers who are exposed to SARS-CoV-2-infected patients at emergency wards, infectious wards, and intensive care units are at a much higher risk of showing symptoms of anxiety, depression, and sleep disorders than healthcare workers working in other wards. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)
Article
Excess Deaths and Hospital Admissions for COVID-19 Due to a Late Implementation of the Lockdown in Italy
Int. J. Environ. Res. Public Health 2020, 17(16), 5644; https://doi.org/10.3390/ijerph17165644 - 05 Aug 2020
Cited by 9 | Viewed by 1383
Abstract
In Italy, the COVID-19 epidemic curve started to flatten when the health system had already exceeded its capacity, raising concerns that the lockdown was indeed delayed. The aim of this study was to evaluate the health effects of late implementation of the lockdown [...] Read more.
In Italy, the COVID-19 epidemic curve started to flatten when the health system had already exceeded its capacity, raising concerns that the lockdown was indeed delayed. The aim of this study was to evaluate the health effects of late implementation of the lockdown in Italy. Using national data on the daily number of COVID-19 cases, we first estimated the effect of the lockdown, employing an interrupted time series analysis. Second, we evaluated the effect of an early lockdown on the trend of new cases, creating a counterfactual scenario where the intervention was implemented one week in advance. We then predicted the corresponding number of intensive care unit (ICU) admissions, non-ICU admissions, and deaths. Finally, we compared results under the actual and counterfactual scenarios. An early implementation of the lockdown would have avoided about 126,000 COVID-19 cases, 54,700 non-ICU admissions, 15,600 ICU admissions, and 12,800 deaths, corresponding to 60% (95%CI: 55% to 64%), 52% (95%CI: 46% to 57%), 48% (95%CI: 42% to 53%), and 44% (95%CI: 38% to 50%) reduction, respectively. We found that the late implementation of the lockdown in Italy was responsible for a substantial proportion of hospital admissions and deaths associated with the COVID-19 pandemic. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)
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Article
COVID-19 Outbreak in North Italy: An Overview on Dentistry. A Questionnaire Survey
Int. J. Environ. Res. Public Health 2020, 17(11), 3835; https://doi.org/10.3390/ijerph17113835 - 28 May 2020
Cited by 31 | Viewed by 3629
Abstract
This survey assessed the symptoms/signs, protective measures, awareness, and perception levels regarding COVID-19 among dentists in Lombardy, Italy. Moreover, an analysis of the answers gathered in areas with different prevalence of the disease was carried out. All Lombardy’s dentists were sent an online [...] Read more.
This survey assessed the symptoms/signs, protective measures, awareness, and perception levels regarding COVID-19 among dentists in Lombardy, Italy. Moreover, an analysis of the answers gathered in areas with different prevalence of the disease was carried out. All Lombardy’s dentists were sent an online ad hoc questionnaire. The questionnaire was divided into four domains: personal data, precautionary measures (before patient arrival; in the waiting room; in the operating room), awareness, and perception. Three thousand five hundred ninety-nine questionnaires were analyzed. Five hundred two (14.43%) participants had suffered one or more symptoms referable to COVID-19. Thirty-one subjects were positive to the virus SARS-CoV-2 and 16 subjects developed the disease. Only a small number of dentists (n = 72, 2.00%) were confident of avoiding infection; dentists working in low COVID-19 prevalence areas were more confident than those working in the Milan area and high prevalence area (61.24%, 61.23%, and 64.29%, p < 0.01 respectively). The level of awareness was statistically significantly higher (p < 0.01) in the Milan area (71.82%) than in the other areas. This survey demonstrated that dentists in the COVID-19 highest prevalence area, albeit reported to have more symptoms/signs than the rest of the sample, were the ones who adopted several precautionary measures less frequently and were the more confident of avoiding infection. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

Review

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Review
COVID-19 and Dentistry: Prevention in Dental Practice, a Literature Review
Int. J. Environ. Res. Public Health 2020, 17(12), 4609; https://doi.org/10.3390/ijerph17124609 - 26 Jun 2020
Cited by 20 | Viewed by 4904
Abstract
SARS-CoV-2 is a member of the family of coronaviruses. The first cases were recorded in Wuhan, China, between December 2019 and January 2020. Italy is one of the most affected countries in Europe. COVID-19 is a new challenge in modern dentistry. New guidelines [...] Read more.
SARS-CoV-2 is a member of the family of coronaviruses. The first cases were recorded in Wuhan, China, between December 2019 and January 2020. Italy is one of the most affected countries in Europe. COVID-19 is a new challenge in modern dentistry. New guidelines are required in dental clinics to avoid contagion caused by cross-infections. A narrative review was performed using both primary sources, such as scientific articles and secondary ones, such as bibliographic indexes, web pages, and databases. The main search engines were PubMed, SciELO, and Google Scholar. Twelve articles were selected to develop the bibliographic review by applying pre-established inclusion and exclusion criteria. Precautionary measures should be applied to control COVID-19 in clinical practice. Several authors have highlighted the importance of telephone triage and/or clinic questionnaires, body temperature measurement, usage of personal protective equipment, surface disinfection with ethanol between 62% and 71%, high-speed instruments equipped with an anti-retraction system, four-handed work, and large-volume cannulas for aspiration. Clinically, the use of a rubber dam is essential. FFP2 (or N95) and FFP3 respirators, if compared to surgical masks, provide greater protection for health workers against viral respiratory infections. Further accurate studies are needed to confirm this. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)
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Other

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Project Report
Study Protocol for an Online Questionnaire Survey on Symptoms/Signs, Protective Measures, Level of Awareness and Perception Regarding COVID-19 Outbreak among Dentists. A Global Survey
Int. J. Environ. Res. Public Health 2020, 17(15), 5598; https://doi.org/10.3390/ijerph17155598 - 03 Aug 2020
Cited by 8 | Viewed by 3819
Abstract
The Centres for Disease Control and Prevention and the World Health Organization have developed preparedness and prevention checklists for healthcare professionals regarding the containment of COVID-19. The aim of the present protocol is to evaluate the impact of the COVID-19 outbreak among dentists [...] Read more.
The Centres for Disease Control and Prevention and the World Health Organization have developed preparedness and prevention checklists for healthcare professionals regarding the containment of COVID-19. The aim of the present protocol is to evaluate the impact of the COVID-19 outbreak among dentists in different countries where various prevalence of the epidemic has been reported. Several research groups around the world were contacted by the central management team. The online anonymous survey will be conducted on a convenience sample of dentists working both in national health systems and in private or public clinics. In each country/area, a high (~5–20%) proportion of dentists working there will be invited to participate. The questionnaire, developed and standardized previously in Italy, has four domains: (1) personal data; (2) symptoms/signs relative to COVID-19; (3) working conditions and PPE (personal protective equipment) adopted after the infection’s outbreak; (4) knowledge and self-perceived risk of infection. The methodology of this international survey will include translation, pilot testing, and semantic adjustment of the questionnaire. The data will be entered on an Excel spreadsheet and quality checked. Completely anonymous data analyses will be performed by the central management team. This survey will give an insight into the dental profession during COVID-19 pandemic globally. Full article
(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)
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