PONE-D-21-11259

Improving Oral Health in People with Severe Mental Illness (SMI): A Systematic Review

PLOS ONE

Dear Dr. Macnamara,

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.

The reviewers have identified significant concerns on your submission. Please carefully consider all the reviewers' comments and address them fully if you plan to resubmit.

Please submit your revised manuscript by Jun 11 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Ratilal Lalloo

Academic Editor

PLOS ONE

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Reviewers' comments:

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Partly

Reviewer #2: Partly

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

Reviewer #3: N/A

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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5. Review Comments to the Author

Reviewer #1: Thank you very much for the opportunity to review the paper entitled “Improving Oral Health in People with Severe Mental Illness (SMI): A Systematic Review.” In this work, the authors try to summarize the results of studies that focused on interventions to improve the oral health of individuals with SMI such as schizophrenia and bipolar disorders. The topic is interesting since few reviews have been conducted on the topic and authors tried to be comprehensive in terms of interventions and oral health outcomes. That being said, there are some concerns regarding the methodology and preparation of the report that need to be addressed before the paper can be considered for publication.

Introduction

The introduction is well written and informative for readers who are not familiar with interdisciplinary topics such as the current paper. Some previous studies and reviews were mentioned and the gap in knowledge was described.

Methods

It is suggested that the participant, intervention, comparison, and outcome (PICO) framework be used to formulate the research focused question. In that way, readers will have a more clear idea of what to expect from the paper.

Eligibility Criteria

Page5, L 88. What authors mean by adults? What is the age range?

Page 5, L 90. It is suggested that authors describe more in detail the other psychotic disorder since readers in the field of dentistry may not be familiar with them.

Authors need to clearly define inclusion and exclusion criteria under separate subheadings so it would be easier for readers to follow.

Page 5 L 92. What do authors mean by dual diagnosis exactly? SMI and another psychological disorder?

Data Sources

Authors need to mention the exact month for their systemic search in 2020 for each database.

Study Selection

Why 90% of the screening of titles and abstracts were done by one author? It’s not a common approach in conducting systematic reviews and usually 2 authors screen all the records. Moreover, does 100% agreement between the two authors, when piloting for 10% of the records, refer to those papers that were excluded, included, or both? If it only refers to excluded papers, it can be a source of bias.

Possible Missed Papers in the Review

Only seven papers were included in this review which consequently prevents authors from conducting meta-analysis due to heterogeneity. By a quick search only in PubMed, the following papers were found that possibly could have been included in this review.

1. Singhal V, Heuer AJ, York J, Gill KJ. The Effects of Oral Health Instruction, and the Use of a Battery-Operated Toothbrush on Oral Health of Persons with Serious Mental Illness: A Quasi-Experimental Study. Community mental health journal. 2020:1-8.

2. Peteuil A, Rat C, Moussa-Badran S, Carpentier M, Pelletier J-F, Denis F. A therapeutic educational program in oral health for persons with schizophrenia: a qualitative feasibility study. International journal of dentistry. 2018;2018.

3. Kuo M-W, Yeh S-H, Chang H-M, Teng P-R. Effectiveness of oral health promotion program for persons with severe mental illness: a cluster randomized controlled study. BMC oral health. 2020;20:1-9.

4. Denis F, Millot I, Abello N, Carpentier M, Peteuil A, Soudry-Faure A. Study protocol: a cluster randomized controlled trial to assess the effectiveness of a therapeutic educational program in oral health for persons with schizophrenia. International journal of mental health systems. 2016;10:1-10.

5. Jones HF, Adams CE, Clifton A, et al. An oral health intervention for people with serious mental illness (Three Shires Early Intervention Dental Trial): study protocol for a randomised controlled trial. Trials. 2013;14:1-8.

Possibly by conducting a complete search in other databases more papers will be found that have the potential to be included. It’s suggested that authors conduct the literature search again and include any missed papers and revise the Result and Discussion section accordingly.

Results

Page 8 L 162. Only one reference in the bracket was mentioned which seems to be by mistake and the authors intended to cite all the included papers?

It is suggested that the excluded papers in the full-text screening phase will be cited as well.

It is suggested that interventions be mentioned in tables 2 and 3 as well.

Please cite or mention the names and authors of the related papers in Table 4.

Discussion

After including any possible papers this section needs to be revised. The categorization of this section seems to be fine, but it is suggested that authors focus more on synthesizing the results and providing a comprehensive interpretation of them. Some paragraphs are the repetition of the results and lengthy and can be better summarized.

Reviewer #2: Thank you for the opportunity to review your manuscript and I commend you for submitting it. The issue of poor oral health among people living with SMI is an important one.

Your introduction section establishes the importance of the topic, but some of the concepts and dental terminology are not clearly explained. Your study lacked a clear research question, and the inclusion criteria were very broad, so it was unsurprising that there was too much heterogeneity between studies to conduct a meta-analysis (synthesis would require more commonality between studies). Despite such broad criteria, only seven studies were included in the analysis, and two of those were published in the 1970s. The results were presented more like a simple descriptive summary of studies, which minimises the usefulness of the findings. Unfortunately, I do not think this study contributes valuable new findings for practice or research and am therefore not recommending it be accepted for publication.

In considering the quality of the writing, I found myself confused on occasion as some of the comments were rather vague or unclear, and the narrative of the manuscript did not flow well. There were some structural issues with paragraphs and sentences. Try to avoid anthropomorphisms e.g. ‘three studies had some concerns…’ These problems with structure and writing conventions can be easily rectified.

Reviewer #3: Oral health improvement is important for persons with severe mental illness. This review article is well structured and the manuscript content is detailed. Furthermore, it provides more insight for practice and can facilitate further research to enhance oral hygiene for this disadvantaged patient group. However, several points must be addressed before this manuscript can be published.

1. The authors reviewed relevant articles that are published prior to May 2020. I think that the following two articles are relevant and recommend that they be included in the literature review:

(1) Mun, S.J. et al. Reduction in dental plaque in patients with mental disorders through the dental hygiene care programme. Int J Dent Hygiene 2013;12(2):133–40.

(2) Yoshii H, et al. Effects of an educational intervention on oral hygiene and self-care among people with mental illness in Japan: a longitudinal study. BMC Oral Health 2017; 17:81.

Please consider adding these two articles into the literature review.

2. Moreover, if the authors had extended the scope of the literature review to the end of 2020, the review could have included an additional cluster randomized controlled trial (RCT) published by Kuo et al. (Effectiveness of oral health promotion program for persons with severe mental illness: a cluster randomized controlled study. BMC Oral Health 2020; 20:290).

I believe that if the authors had included the abovementioned three articles, the manuscript would be more comprehensive.

3. In the 2nd paragraph of the discussion section, the authors mentioned that oral health education might increase individual awareness of personal oral health in a negative manner. However, Teng, P.R. et al. (Gen Hosp Psychiatry 2011; 33: 253-259) showed that the neglect of oral health in persons with severe mental illness is in part due to the lack of awareness. Specifically, nearly 40% of the psychiatric inpatients rated their oral health as good despite the presence of periodontal pockets. Therefore, a dissatisfactory perception of oral health in an intervention group might not be negative because it could enhance their awareness of poor oral health and motivate them to take actions to improve oral hygiene.

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Do you want your identity to be public for this peer review?

Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Po-Ren Teng

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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Attachments

Attachment

Submitted filename: Dr Teng Plos One comment.doc

PONE-D-21-11259R1Improving oral health in people with severe mental illness (SMI): a systematic reviewPLOS ONE

Dear Dr. Macnamara,

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. A reviewer is concerned about the potential of research papers missing in the review; and recommends this is carefully reviewed. The submission can be further improved, i.e. language, and flow of information. Please submit your revised manuscript by Oct 28 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Ratilal Lalloo

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Reviewers' comments:

1. Previous round of review comments addressed?

Reviewer #1: (No Response)

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Partly

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #3: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Reviewer #1: Thank you very much for submitting the revision of the paper entitled “Improving oral health in people with severe mental illness (SMI): a systematic review.” I can see that the manuscript has been improved compared to the previous version.

When reporting the results using PICO make sure to mention in advance in the text in the Method section and used the appropriate reference. Also, the main research question should be formulated before going into detail about categories. Please see similar papers in the literature to get familiar with the proper reporting format.

Please use the subheading “Inclusion Criteria” instead of “Study Design and Language”

In the response letter, the authors mentioned that qualitative studies were not considered eligible. If this is the case, please mentioned it in your exclusion criteria.

Based on the Prisma flowchart, out of the 5,330 screened records, only 16 studies were considered eligible for full-text reading which is proportionally a low rate implying a strict screening process. As a suggestion, please go through those papers you find closely related and evaluate their eligibility based on the full-text reading to make sure no study is missing. If the number of excluded is fairly small (10 or under), please use a table or explain in more detail the reason for exclusion for each paper specifically.

Regarding the quality of writing and academic style, some editing is needed since the flow is lost in some sections.

Reviewer #3: In the section of abstract, "There is a currently a lack of evidence to suggest..." The double "a" should be deleted to one "a".

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7. Do you want your identity to be public for this peer review?

Reviewer #1: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-21-11259R2Improving oral health in people with severe mental illness (SMI): a systematic reviewPLOS ONE

Dear Dr. Macnamara,

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. Please submit your revised manuscript by Dec 16 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Ratilal Lalloo

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Adequately addressed reviewers' comments?

Reviewer #1: (No Response)

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Partly

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #3: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Reviewer #1: Thank you very much for submitting the revison of the manuscript.

Some of the comments have been address in this versin, but authors need to excersise more caution when reporting the results and findings so that the results will be homogeneous throughout the manuscript. As mentioned before, the Prisma flowchart has not been revised. It clearly mentions in your Prisma flowchart that 5,333 records have been obtained after the dublicates have been removed, and the whole screening process is based on the 5,330 record!

Also in the reposnse letter authors mentioned 1,465 unique record were identified (if this is the case, this number should be reported in the abstract as well). However in the manuscript this number is 1,462! and again 2,073 was mentioned instead of 5,330 in the text for numbers of records before excluding the duplicates! In my opinion, the authors need to address these controversies since for potential readers it will be not possible to know what approch the authors took to select the final inluded studies.

Reviewer #3: The search has now been updated, more articles have been included in the revised manuscript of this review, therefore, I have no more comments.

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7. 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 #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Improving oral health in people with severe mental illness (SMI): a systematic review

PONE-D-21-11259R3

Dear Dr. Macnamara,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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 help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- 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.

Kind regards,

Ratilal Lalloo

Academic Editor

PLOS ONE

Comments to the Author

1. If the authors have adequately addressed your comments.

Reviewer #1: (No Response)

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #3: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Reviewer #1: (No Response)

Reviewer #3: The authors had answered the comments from the reviewers and the study had included all available papers related to study topic. I have no further comment.

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7. 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 #3: No