Is parity a cause of tooth loss? Perceptions of northern Nigerian Hausa women

Elizabeth O. Oziegbe; Lynne A. Schepartz

doi:10.1371/journal.pone.0226158

Peer Review History

Original SubmissionJuly 31, 2019
10 Sep 2019 Decision Letter - Denis Bourgeois, Editor PONE-D-19-21577 Is parity a cause of tooth loss? Perceptions of northern Nigerian Hausa women PLOS ONE Dear Dr. Schepartz, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We would appreciate receiving your revised manuscript by Oct 25 2019 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. 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The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The paper concerns an original issue with interesting data on subjective perception in a sample of women in a developing country about the relationship between tooth loss and parity. Statistical and methodological procedures are described and conducted with the Focus Group Discussion, which is a correct way to assess subjective perceptions in specific cultural environments. Besides, there are several redundancies within the whole text that require an optimization of the text itself that can lead to better overall readability; a thorough English language review is needed as well, in particular in the abstract, introduction, tooth loss and discussion sections. Moreover, authors should explain what the Kolanut is (mentioned in the "Poor Oral Hygiene" paragraph page 9) and should correct the concept stating that untreated gingivitis leads authomatically to periodontitis reported at page 15, second paragraph, line 5. Author should express the possibility of periodontitis development, and not its certainty. Reviewer #2: • The introduction is too long and dispersed. Refocus on the dental problem • "Parity has been linked to tooth loss, although the association remains poorly investigated". This sentence is difficult to understand. Please clarify the meaning • "Tooth loss impacts greatly on the quality of life. The participants in this study perceived that the loss of one or more teeth affects mastication, their appearance, their sense of well-being and their financial status. Functional and esthetic impairments are widely reported in the literature as major effects of tooth loss on individual quality of life [20,23,77]. Fiske et al. [23], in a qualitative study of edentulous patients, documented bereavement, loss of self-confidence, concerns about appearance and self-image as part of the emotional responses to tooth loss. As tooth loss is associated with ageing, individuals may perceive that they are old following the loss of a tooth. Affordability of dental care may be a challenge, especially in developing countries. The participants in this study perceived that replacement of a missing tooth was expensive. This may further reduce their quality of life because their hope of tooth replacement is poor". This sentences are not one of the objectives of the study. • Dental references must be updated • Why do not the authors speak about pregnancy gingivitis, a classic clinical sign between the 3rd month of pregnancy and 45th after childbirth? Comments for the editor: Original qualitative study but whose main criticisms reside in obsolete references associated with a need to condense the introduction ****** 6. 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Revision 1
16 Oct 2019 Author Response Response to Reviewers Note: Due to revisions and deletions, the locations of deletions (Page #, paragraph and line) do not pertain to the new text. A thorough English language revision of the entire text was done to improve the flow in certain sections. Reviewers 1 1. There are several redundancies within the whole text that require an optimization of the text itself that can lead to better overall readability; a thorough English language review is needed as well, in particular in the abstract, introduction, tooth loss and discussion sections. We have deleted the following: Introduction Page 3 paragraph 2 deleted High parity, when a woman has given birth five or more times regardless of whether the child survived, (also referred to as grand multiparity [7]) adversely affects maternal morbidity and in some cases contributes to mortality [8-10]. Increased number of children is associated with greater risk of obesity, diabetes and cardiovascular disease, especially in developed countries [11-14]. Conversely, high parity is linked to lower maternal morbidity in developing countries [15]. In the latter environments, healthier women may have more children simply because they have better access to resources that can sustain pregnancy. Tooth loss Page 3 paragraph 1 lines 1-2 – deleted Teeth play important biological and aesthetic roles in the life of an individual. The loss of a tooth is associated with negative social, functional and psychological consequences. Page 3 paragraph 1 last line –deleted The loss of teeth has negative consequences on the individual irrespective of the reasons for the loss or the life stage in which it occurs. Page 4 paragraph 3 lines 4-5 –deleted Important factors include attitudes toward dental care and availability of resources for treatment. Page 4 last paragraph line 2 – deleted While most researchers used quantitative data to establish a link between the two, Page 5 paragraph 1 lines 4-5 – deleted Therefore, the purpose of this study was to understand the beliefs among Hausa women through development of a theoretical framework explaining the pathways linking their views on parity and tooth loss. Discussion Page 15 paragraph 2 lines 1-3 – deleted Parity has been linked to tooth loss, although the association remains poorly investigated. This study provides information on parity and tooth loss beliefs in women from northern Nigeria. Page 15 paragraph 2 line 6 – deleted Some of the women in the study experienced the phenomenon while Page 18 paragraph 2 line 5– 7 - deleted Fiske et al. [14], in a qualitative study of edentulous patients, documented bereavement, loss of self-confidence, concerns about appearance and self-image as part of the emotional responses to tooth loss 2. Authors should explain what the Kolanut is (mentioned in the "Poor Oral Hygiene" paragraph page 9) and should correct the concept stating that untreated gingivitis leads authomatically to periodontitis reported at page 15, second paragraph, line 5. Kolanut has been explained under “Poor Oral Hygiene” page 10 paragraph 1. Kolanut, a mild stimulant chewed to restore vitality and reduce hunger pangs, results in staining of teeth and was associated with poor oral hygiene. Re untreated gingivitis. Thank you. Agreed. The concept that untreated gingivitis automatically leads to periodontitis has been amended. We expressed the possibility of periodontitis and not its certainty – Page 16 paragraph 1 Response to Reviewer 2 3. The introduction is too long and dispersed. Refocus on the dental problem We made deletions in response to this comment and to Reviewer 1. See point one for Reviewer 1 above. 4. "Parity has been linked to tooth loss, although the association remains poorly investigated". This sentence is difficult to understand. Please clarify the meaning Thank you. The sentence is deleted as unnecessary as the point is made elsewhere. 5. "Tooth loss impacts greatly on the quality of life. The participants in this study perceived that the loss of one or more teeth affects mastication, their appearance, their sense of well-being and their financial status. Functional and esthetic impairments are widely reported in the literature as major effects of tooth loss on individual quality of life [20,23,77]. Fiske et al. [23], in a qualitative study of edentulous patients, documented bereavement, loss of self-confidence, concerns about appearance and self-image as part of the emotional responses to tooth loss. As tooth loss is associated with ageing, individuals may perceive that they are old following the loss of a tooth. Affordability of dental care may be a challenge, especially in developing countries. The participants in this study perceived that replacement of a missing tooth was expensive. This may further reduce their quality of life because their hope of tooth replacement is poor". This sentences are not one of the objectives of the study. In the methods section, under data collection method, we referred to obtaining information on the effects of tooth loss on the quality of lives of the women. Page 6 paragraph 4. Thus the above should not be deleted because it is the aspect of the discussion on the participant’s responses to the effects of tooth loss on their quality of life. We did delete the sentence on Fiske’s work as it was previously mentioned. 6. Dental references must be updated. We are unable to respond directly to this comment, as it does not tell us specifically what areas need to be updated. We checked our references with this comment in mind. We do include a few ‘historic’ references where appropriate to provide context, but otherwise our cited literature is current. The sources on oral health for Northern Nigeria are, sadly, the latest available statistics. 7. Why do not the authors speak about pregnancy gingivitis, a classic clinical sign between the 3rd month of pregnancy and 45th after childbirth? Pregnancy gingivitis, and the clear acute clinical symptoms associated with it, did not emerge as a cause of tooth loss in the focus group discussions. However, we did refer to it in our discussion under https://doi.org/10.1371/journal.pone.0226158.r002
21 Nov 2019 Decision Letter - Denis Bourgeois, Editor Is parity a cause of tooth loss? Perceptions of northern Nigerian Hausa women PONE-D-19-21577R1 Dear Dr. Schepartz, We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Denis Bourgeois Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: (No Response) Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: (No Response) Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: (No Response) Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No https://doi.org/10.1371/journal.pone.0226158.r003
Formally Accepted
26 Nov 2019 Acceptance Letter - Denis Bourgeois, Editor PONE-D-19-21577R1 Is parity a cause of tooth loss? Perceptions of northern Nigerian Hausa women Dear Dr. Schepartz: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Denis Bourgeois Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0226158.r004

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