Responsibility in the time of the COVID-19 pandemic

OBJECTIVES The COVID-19 pandemic had severe consequences on the health system, involving dental structures and professionals. VI the first phase of the emergency, the delivery of dental care was limited to emergencies. During the following phases. the clinical activity will be extended to the treatments suspended due to the COVID-19 emergency and to therapies that cannot be postponed without risk for oral health of patients. DISCUSSION The work of dental professionals takes place close to the patient's mouth, without protection, in a situation that involves aerosol generation. At present, there is no procedure able to eliminate the cross-infection risk, neither for patients nor for dental staff. Therefore the dentist can be claimed for negligence in the case of SARSCoV-2 infection of the patient, if this one assumes to become infected during the dental care session. In this case, the clinical recommendations and good clinical practices issued by institutions or scientific societies, according to Law 24/2017 (so-called Gelli-Bianco law), are of great importance. There is a discussion about the possibility that COVID-19 emergency could lead, at least in certain circumstances, to the mitigation of liability of professionals and healthcare structures. This could be true both in the case of claims for compensation by a patient who complain cross-infection and by the worker who takes action against the employer. There are many interpretations based on the availability of valid and evidence-based preventive measures available at the moment in which COVID-19 pandemic occurred. On the other hand. the same interpretations take into account the reason why such possible precautions have not been respected. The possible offense could only occur if valid measures were available, and the healthcare professional did not respect them without a valid reason. Talking about the responsibility towards the patient, a central role is played by the possibility by the healthcare professional to demonstrate the validity of treatment indications (in that pandemic/ epidemic phase). A careful balancing of the risks provided by the different treatment options must also be performed. The information to the patient for COVID-19 has the dual purpose: to obtain the highest compliance with the preventive measures (triage, behavior in the studio etc.) and to make him aware of the risk of developing severe forms of COVID-19. SARS-CoV-2 cross-infection during work represents an increase in the biological risk typical of dental structures. For this reason, actions are required about the Risk Assessment Document (DVR) and in terms of health surveillance of workers by the occupational physician. Within dental structures, workers exposed to specific or general aggravated risk can be identified. From this situation can emerge the work accident with consequent compensation for the SARS-CoV-2 contagion by INAIL. The civil or criminal liability of the employer is based on different assumptions and requires proof of the tort or the crime. CONCLUSIONS Dental work is carried out close to the patient mouth without airway protection and a significant amount of aerosol can be produced. The pandemic created new profiles of professional responsibility both towards the patient and towards the worker. CLINICAL SIGNIFICANCE Knowledge of the procedures for the prevention of contagion as well as of the new profiles of responsibility towards workers and patients leads the professional to a more aware and careful professional practice. Govemment and scientific societies play a central role, providing indications aimed at risk prevention. These must be systematically calibrated and reviewed as the pandemic scenario changes considering the medical/ legal value they have.