A naturalistic study of brushing patterns using powered toothbrushes

Mahmoud Essalat; Douglas Morrison; Sumukh Kak; E. Jun Chang; Isabel Roig Penso; Rachel J. Kulchar; Oscar Hernan Madrid Padilla; Vivek Shetty

doi:10.1371/journal.pone.0263638

Peer Review History

Original SubmissionFebruary 2, 2022
7 Mar 2022 Decision Letter - Tanay Chaubal, Editor PONE-D-22-02067A naturalistic study of brushing patterns using electric toothbrushesPLOS ONE Dear Dr. Mahmoud Essalat, 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 Apr 21 2022 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, Tanay Chaubal Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. Additional Editor Comments: Dear Dr Mahmoud Essalat, I congratulate you on writing a manuscript on a novel concept. However, there are some comments from the reviewers. Kindly address those comments. Thank you. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. 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 Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know 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: Yes 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: Yes 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 authors have conducted a study on 12 participants to study their natural brushing habits using a rotation oscillation toothbrush. This study attempts to aggregate the data that is available when participants use these brushes at home rather than a professional setting. Although this is a strength of this study, the study does not appear to provide sufficient aggregated statistical data (although it appears that it was done) to substantiate the results and conclusions from the study. The study also might be under powered with only 12 participants (the authors have not provided how the sample size was arrived at). GENERAL COMMENTS: The authors use the word electric toothbrushes throughout the study (and title). Since the type of toothbrush studied here was only of the rotation oscillation type, it cannot be generalized to all types of electric toothbrushes. The authors need to use more specific language across the full text and title to correctly represent what is being studied. In addition, it appears that the participants were video recorded during all sessions of tooth brushing (needs clarification from authors). Although it might be closer to their natural home practices than studying it in a professional setting, it still does not fully resemble a naturalistic brushing patters. Consider rewording the title and abstract/full text information to “at home” rather than naturalistic. ABSTRACT: 1. Abstract states “analysis of brushing patterns from 120 sessions” – this statement is misleading as it appears that 120 sessions from each participant was studied. Please be more specific that it was 10 per participant and 120 in total. 2. Please use statistical values wherever appropriate when elaborating results. If not statistically significant – please state so. INTRODUCTION: 1. Page 3, Line 56-58: The authors state that “the considerable unexplained heterogeneity” – the authors have not raised this issue nor are there references to this statement. Please consider identifying key references that support this statement and include a few lines summary to substantiate this statement since this seems to form the central theme of the relevance of this study. MATERIALS AND METHODS: 1. How was the sample size arrived at? Was this study adequately powered? Please provide information on power calculation 2. Why only 10 out of 50 sessions were used? How were they randomly selected? 3. It is not clear how duration for each sextant surface that was brushed was observed and calculated – please clarify. 4. Were these participants already using electric toothbrushes before? Were they provided any information of how to use them? Did they have any dental diseases? Please include this information as it is pertinent to the study. 5. Although the statistical methods used are described in sufficient detail, the outcome of the analysis is lacking in the paper and are not presented in the appropriate locations to substantiate the important results and conclusions. RESULTS: 1. Page 8, 9, Line 167- 172: No statistical values are reported to substantiate statements like “substantial variation”. Also, the authors state “estimated variability” – were they not directly measured? 2. Page 9, Line 189-191: No statistical values are reported to substantiate statements. 3. Page 10, Line 196-199: No statistical values are reported to substantiate statements. DISCUSSION: 1. Page 11, Line 220-222: The authors state “Our study showed that electric toothbrushes are not used optimally for plaque removal.” Plaque removal was not measured as part of this study and this line would be an extrapolation of the results that is best avoided. 2. There are some redundant sentences in the discussion. Specifically, Page 10, 11 Lines 210 – 212 and Page 11 Line 224-225. 3. Page 12, Line 249, 251: Was the high criterion validity measured by the authors in this study? 4. Page 13, Line 260-263: The authors state “dentally aware group.” Please clarify the nature of this population. FIGURES AND GRAPHS: Figures requires titles and footnotes. Reviewer #2: Well constructed study. 1. Please be consistent between the terms "electric" and "powered". 2.Age range and gender have not been mentioned in materials and methods. 3. Why were the participants not given the manufacturer's brushing instructions? ****** 6. 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 [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. https://doi.org/10.1371/journal.pone.0263638.r001
Revision 1
18 Mar 2022 Author Response A naturalistic study of brushing patterns using electric toothbrushes Essalat, Morrison, Kak, Chang, Roig, Kulchar, Padilla, Shetty [PONE-D-22-02067] - [EMID:48f78bddccdd4d40] Responses to the reviewers’ comments Dear Editor, Please find enclosed our revised manuscript. We are heartened that our submission was resonant with the reviewers and thank them for their constructive comments. Where appropriate, we have revised the manuscript accordingly and provide our specific responses below. Reviewer #1 comments: the study does not appear to provide sufficient aggregated statistical data (although it appears that it was done) to substantiate the results and conclusions from the study. The study also might be under powered with only 12 participants (the authors have not provided how the sample size was arrived at). We have added a paragraph in materials and methods to clarify this point. Specifically, our observational study was not designed to detect a predetermined difference in measurement between two groups (power). The focus of our study was on clarifying individual differences in terms of toothbrushing duration, dental regions covered, and episodes of excessive brushing pressure in each dental region. The authors use the word electric toothbrushes throughout the study (and title). Since the type of toothbrush studied here was only of the rotation oscillation type, it cannot be generalized to all types of electric toothbrushes. The authors need to use more specific language across the full text and title to correctly represent what is being studied. As suggested, we have changed replace the term” electric” with the more appropriate “powered” toothbrush through the revised manuscript. In addition, it appears that the participants were video recorded during all sessions of tooth brushing (needs clarification from authors). Although it might be closer to their natural home practices than studying it in a professional setting, it still does not fully resemble a naturalistic brushing pattern. Consider rewording the title and abstract/full text information to “at home” rather than naturalistic. While this may be a matter of semantics, naturalistic is the term more commonly used in mHealth research to describe data collected in the natural environments. The “at-home” may be a misnomer in the case of our student participants who conducted the brushing sessions in their student residences/dorms. ABSTRACT: 1. Abstract states “analysis of brushing patterns from 120 sessions” – this statement is misleading as it appears that 120 sessions from each participant was studied. Please be more specific that it was 10 per participant and 120 in total. As suggested, we have corrected that statement to “total 120 sessions” and clarified through greater specificity of the language (10 sessions per participant and 120 in total). 2. Please use statistical values wherever appropriate when elaborating results. If not statistically significant – please state so. As suggested, we have added the p-values and confidence intervals. INTRODUCTION: 1. Page 3, Line 56-58: The authors state that “the considerable unexplained heterogeneity” – the authors have not raised this issue nor are there any references to this statement. Please consider identifying key references that support this statement and include a few lines summary to substantiate this statement since this seems to form the central theme of the relevance of this study. As suggested, we have improved the explanation and added the corresponding reference. Specifically, we now state “The considerable heterogeneity in plaque removal with powered toothbrushes (I(2) > 80%) observed in [5], could not be explained by the difference in types of powered toothbrushes, and may more likely be explained by varying toothbrushing patterns. MATERIALS AND METHODS: 1. How was the sample size arrived at? Was this study adequately powered? Please provide information on power calculation We used convenience sampling for our study that utilized repeated measures. The sample size was based on previous studies [1, 2] which had recruited 12, 10, and 12 subjects. Given the observational nature of the study of individual differences, no power calculation was performed. We submit that our use of confidence intervals and p-values are sufficient to identify trends and results that were statistically significant. 2. Why only 10 out of 50 sessions were used? How were they randomly selected? Annotating videos for machine learning purposes is a very time and resource intensive task. For elucidating individual variability, we choose to focus on annotating 10 sessions out of the of 50 sessions provided by each participant. The sessions for annotation were selected randomly with each brushing session having an equal chance of being selected. The “Data Processing and Annotation” subsection has been updated to reflect this point. 3. It is not clear how duration for each sextant surface that was brushed was observed and calculated – please clarify. The revised “Data Processing and Annotation” subsection clarifies this now. Specifically, “Every epoch of brushing a dental region that lasted more than 0.5 second was annotated by marking the beginning and end timestamp of that brushing epoch.” 4. Were these participants already using electric toothbrushes before? Were they provided any information of how to use them? Did they have any dental diseases? Please include this information as it is pertinent to the study. As the text clarifies, the participants were young healthy college students with no dental disease. None had prior experience with powered toothbrushes. Basic instruction on the use of the brush and setting up the data collection system was given and then the participants were instructed to freely brush their teeth in a manner most natural to them (i.e., no structure brushing patterns, such as the Bass method, were prescribed). 5. Although the statistical methods used are described in sufficient detail, the outcome of the analysis is lacking in the paper and are not presented in the appropriate locations to substantiate the important results and conclusions. As suggested, we have amplified on this in greater detail now (also see response to comment 1 above) RESULTS: 1. Page 8, 9, Line 167- 172: No statistical values are reported to substantiate statements like “substantial variation”. Also, the authors state “estimated variability” – were they not directly measured? We added the coefficient of variation and consider it to be substantial since it is larger than 5%. Also, we added this to the section A3 in the supplementary file. We changed the term “estimated” to “observed” since it is empirically measured. 2. Page 9, Line 189-191: No statistical values are reported to substantiate statements. We have now included the coefficient of variations for all the regions brushed by all the participants in the supplementary file subsection A2.2. We now state that: “Coefficient of variation for all the regions that were brushed during a brushing session was greater than 20%. (See S1 Appendix A2). “ Also, we now included the p-value and confidence intervals for the claimed observations. DISCUSSION: 1. Page 11, Line 220-222: The authors state “Our study showed that electric toothbrushes are not used optimally for plaque removal.” Plaque removal was not measured as part of this study and this line would be an extrapolation of the results that is best avoided. We agree and have removed that sentence. 2. There are some redundant sentences in the discussion. Specifically, Page 10, 11 Lines 210 – 212 and Page 11 Line 224-225. We removed the redundancies. 3. Page 12, Line 249, 251: Was the high criterion validity measured by the authors in this study? We have removed that sentence. 4. Page 13, Line 260-263: The authors state “dentally aware group.” Please clarify the nature of this population. We have now clarified them as college students. FIGURES AND GRAPHS: Figures requires titles and footnotes. We were following PLOS ONE guidelines that instruct authors, “Do not include author names, article title, or figure number/title/caption within figure files. That information will go into your figure caption in the manuscript.” Reviewer #2 comments: 1. Please be consistent between the terms "electric" and "powered". As suggested, electric has been replaced with powered. 2. Age range and gender have not been mentioned in materials and methods. This is now included in the Materials and Methods section. 3. Why were the participants not given the manufacturer's brushing instructions? There are no specific manufacturers’ instructions. However, participants were instructed on how to set up the brush and data collection equipment- they then brushed using their natural preferences. Details are now provided in the Materials and Methods section. References: [1] Huang H, Lin S. Toothbrushing monitoring using wrist watch. In Proceedings of the 14th ACM Conference on Embedded Network Sensor Systems CD-ROM 2016 Nov 14 (pp. 202-215). [2] Luo C, Feng X, Chen J, Li J, Xu W, Li W, Zhang L, Tari Z, Zomaya AY. Brush like a dentist: accurate monitoring of toothbrushing via wrist-worn gesture sensing. In IEEE INFOCOM 2019-IEEE Conference on Computer Communications 2019 Apr 29 (pp. 1234-1242). IEEE. [3] Lee YJ, Lee PJ, Kim KS, Park W, Kim KD, Hwang D, Lee JW. Toothbrushing region detection using three-axis accelerometer and magnetic sensor. IEEE Transactions on Biomedical Engineering. 2011 Dec 22;59(3):872-81. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0263638.r002
5 Apr 2022 Decision Letter - Tanay Chaubal, Editor PONE-D-22-02067R1A naturalistic study of brushing patterns using powered toothbrushesPLOS ONE Dear Dr. Mahmoud Essalat, 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. ==============================Kindly address the comments mentioned by the reviewers. ============================== Please submit your revised manuscript by May 20 2022 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, Tanay Chaubal 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. 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: (No Response) 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: Partly Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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: Yes 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: Yes 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: Some comment(s) have not been addressed (the comment says it has been). Specifically: 1. There are some redundant sentences in the discussion. Specifically, Page 10, 11 Lines 210 – 212 and Page 11 Line 224-225. Reviewer #2: Well written manuscript. suitable for acceptance. the concept of the manuscript is novel and gives an insight into the brushing pattern of subjects who have had no directions on how to brush. ****** 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 [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. https://doi.org/10.1371/journal.pone.0263638.r003
Revision 2
12 Apr 2022 Author Response Dear Editor, I am delighted to learn the favorable reaction of the reviewers. Allow me to clarify the residual issue of redundant sentences (Critique 6- Reviewer 1). There are some redundant sentences in the discussion. Specifically, Page 10, 11 Lines 210 – 212 and Page 11 Line 224-225. In writing the discussion, we followed the general guidelines provided by PLOS (https://plos.org/resource/how-to-write-conclusions/). The first paragraph of the discussion section provides a high-level summary of our main findings. The subsequent paragraphs begin with a brief description of each finding, followed by a brief interpretation of the finding and a comparison/contrast with findings by other investigators. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0263638.r004
4 May 2022 Decision Letter - Tanay Chaubal, Editor A naturalistic study of brushing patterns using powered toothbrushes PONE-D-22-02067R2 Dear Dr. Mahmoud Essalat, 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, Tanay Chaubal 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: (No Response) ******** 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: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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: 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: 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) ****** 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 https://doi.org/10.1371/journal.pone.0263638.r005
Formally Accepted
11 May 2022 Acceptance Letter - Tanay Chaubal, Editor PONE-D-22-02067R2 A naturalistic study of brushing patterns using powered toothbrushes Dear Dr. Essalat: I'm 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 let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Tanay Chaubal Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0263638.r006

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