PONE-D-22-19700Oral characteristics and dietary habits of preterm children: A retrospective study using a nationwide infant medical and oral screening cohortPLOS ONE

Dear Dr. Kang,

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 Oct 27 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.

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• 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'.
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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Kuo-Cherh Huang

Academic Editor

PLOS ONE

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2. Thank you for stating the following in the Acknowledgments Section of your manuscript: 

"We are grateful to Ji Young Park for assistance for data collection. This study used NHIS-INCHS data (NHIS-2021-2-104) made by National Health Insurance Service (NHIS). The authors declare no conflict of interest with the NHIS."

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"This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No. NRF-2020R1G1A1100275) award to CMK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

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Additional Editor Comments:

Dear Dr. Kang,

We appreciate your submission to PLoS ONE. Although your paper is interesting, all three reviewers have provided a variety of important concerns, notably the research methodology and data analyses as well as presentations of analytical results of your study. Here, I would like to bring up a couple of critical points:

From Reviewer 1: “In addition, if it’s a true longitudinal study, you should follow-up the patient during the observation period to observe oral health and changes in lifestyle that can affect it.”; “The survey was only about the ratio and type of premature birth, analysis, and questionnaire, but I don’t think there’s any strong correlation, and there is lack of explanatory power to assess the results from citing other studies.” It is quite evident that you need to defend your research methodology and statistical techniques; otherwise, you should revise them, accordingly.

From Reviewer 2: “However, the authors merely presented the limited findings by a simple analytical fashion. In this retrospective study, readers may be interested in the differences in the potential factors for the poor oral health (as well as dietary habits or fewer dental treatment experiences) between the preterm birth and the full-term birth groups. The authors should perform the relevant regression analysis to explore them.” By the same token, Reviewer 2 had grave concerns with respect to your statistical analyses as Reviewer 1 held.

From Reviewer 3: “The current table and picture are not enough to show the results and conclusions. For example, the percentages listed in Figure 2 are intuitively difficult to understand.”; “There are some parts in the text that don't match the percentage. In a study using big data, accurate arithmetic expression without errors is essential to assert the characteristics of groups through representative values and present them as conclusions.” As Reviewer 3 　sharply pointed out, you need to be more careful about the validity and accuracy of statistics in your work.

Please respond to each comment of the reviewers carefully and thoroughly. Please explain where you feel you cannot completely agree with reviewers’ suggestions.

Kuo-Cherh Huang

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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: Partly

Reviewer #2: Partly

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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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: No

Reviewer #3: Yes

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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

Reviewer #3: Yes

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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 manuscript is very interesting as the first national study to investigate the current status of premature babies and the lifestyle related to oral health. However, there are some shortcomings that require improvement. In the research method, it is necessary to explain more accurately what items were investigated in this study. Currently, there are only survey contents, and it is necessary to describe what content was extracted as a key element and compared based on the answers of the survey.

In addition, if it’s a true longitudinal study, you should follow-up the patient during the observation period to observe oral health and changes in lifestyle that can affect it. Alternatively, different samples should be investigated on the premise that the population is the same at different points in time so that they can know the change from year to year. In the current study, it is difficult to say that it is a true longitudinal study though it has period to increase the number of samples.

The only difference between the experimental group and the control group is the difference in perception of the parents' oral health at 42-53 months. There is a slight statistically significant difference. Why? should be dealt with in more detail in the consideration.

If the babies come to the dentist more often, more treatment will be done, and if there is no significant difference in oral condition, you may even conclude that full-term children's oral health is worse than preterm children. Since the questionnaire items of national screening are too simple, it is difficult to compare the information of the two groups. All explanations are not based on the results obtained in the current study, but are all guessed using previous studies. Changes in oral conditions and oral health habits according to age changes have not been studied.

Now, I will ask the author who submitted the manuscript.

First, why didn't you use the latest data?

Second, why did you not attempt to interpret it in connection with oral condition data such as dmfs?

Third, why didn't you study the data (year) collected at different points in time?

The survey was only about the ratio and type of premature birth, analysis, and questionnaire, but I don’t think there’s any strong correlation, and there is lack of explanatory power to assess the results from citing other studies. Although it has the advantage of being the first nationwide research, it is not suitable for publication due to insufficient research contents. Please reinforce the contents after a major revision and submit it again.

Reviewer #2: (1) The authors concluded that preterm infants had poor oral health and dietary habits and fewer dental treatment experiences than full-term infants. There were many valuable variables collected in the nationwide cohort study. However, the authors merely presented the limited findings by a simple analytical fashion. In this retrospective study, readers may be interested in the differences in the potential factors for the poor oral health (as well as dietary habits or fewer dental treatment experiences) between the preterm birth and the full-term birth groups. The authors should perform the relevant regression analysis to explore them.

(2) In this study, data on socio-economic variables, disability, and medical resource utilization status such as consultations and medical screening were collected; please show the information, which giving readers a clear feature regarding the study population.

(3) Please place the numbers of the preterm birth and the full-term birth groups respectively in Tables 2, 3 and 4, which can make the relevant information clear and easy for readers to understand.

Reviewer #3: 1. The author's study shows that the oral hygiene-related characteristics of preterm baby are very bad and dangerous compared to full-term baby, and it would be better to show it in an arithmetically impactful schematic that is easier to understand.

2. The current table and picture are not enough to show the results and conclusions. For example, the percentages listed in Figure 2 are intuitively difficult to understand.

3. There are some parts in the text that don't match the percentage. In a study using big data, accurate arithmetic expression without errors is essential to assert the characteristics of groups through representative values and present them as conclusions.

4. The comparison of oral characteristics of preterm baby and full term baby shown in Table 3 shows no significant difference in all cases except for '42-53 months of oral hygiene'. Considering the tone of the text that Preterm baby is not better, Table 3 seems to show the opposite results.

5. In addition, "food impaction", "poor oral hygiene", and "visible dental plaque" are all overlapping items, but they all marked differently and processed statistics separately, so please explain why they were classified separately.

6. "Parent-reported poor oral hygiene and food impaction between teeth (Table 3) at the age of 42–53 months was higher in the preterm group than in the full-term group (p < 0.05)."

=> In addition, according to Table 3 in this sentence, 'food impaction' does not show a significant difference, but it is stated that it shows a significant difference together.

7. The results in Table 4 show that the full-term birth group as a whole received more dental treatment in most items than the preterm birth group. However, from these results, it may be interpreted that the full-term birth group is good at dental care, but it may be interpreted that the full-term birth group had more cavities and received more treatment. Therefore, it seems that the clinical data should be further supplemented for accurate analysis of Table 4.

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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.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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PONE-D-22-19700R1Oral characteristics and dietary habits of preterm children: A retrospective study using National Health Screening Program for Infants and ChildrenPLOS ONE

Dear Dr. Kang,

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 Feb 03 2023 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,

Kuo-Cherh Huang

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.

Additional Editor Comments :

Dear Dr. Kang,

Thank you for submitting your revised manuscript to PLoS ONE. I have carefully read your revised manuscript and responses to the previous round of review comments. I appreciate your efforts. Although Reviewer 1 recommended favorably regarding your revised work, Reviewer 2 still held strong opinions against your paper. The critical concern of Reviewer 2 was related to your statistical analysis: “The authors still presented the limited findings by a simple analytical fashion in the revised manuscript. In this retrospective study, readers may be interested in the differences in the potential factors for the poor oral health (as well as dietary habits or fewer dental treatment experiences) between the preterm birth and the full-term birth groups. The authors can use the relevant regression analysis to explore them in the preterm birth and the full-term birth groups, respectively. Why did the authors NOT perform these regression analyses?” Actually, a similar issue was raised by Reviewer 1 in his/her previous review comments: “… but I don’t think there’s any strong correlation, and there is lack of explanatory power to assess the results from citing other studies. Although it has the advantage of being the first nationwide research, it is not suitable for publication due to insufficient research contents”.. Even though in your rebuttal letter you had explained why you opted not to carry out regression modeling, it is quite obvious that Reviewer 2 was not convinced at all by your rationales.

One criterion for publication at PLoS ONE is: ”Experiments, statistics, and other analyses are performed to a high technical standard and are described in sufficient detail.” I think it would be better to present the statistics (results of regression analysis) and let the reader read and make their own judgment in respect of the study power of your work, instead of simply arguing that “we did not find too many outcomes with significant difference from this study and thus decided regression model is not fit for this manuscript.” In fact, it is kind of surprising to me with reference to the declared outcomes, considering it is a nationwide, population-based longitudinal study and the sample size is sufficiently large (N = 84,005).

Kuo-Cherh Huang

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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: (No Response)

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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: Yes

Reviewer #2: No

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

Reviewer #1: Yes

Reviewer #2: No

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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: No

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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: No

**********

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: I am pleased to be in charge of the review of the revised paper. I have confirmed that very sincere responses and corrections have been made to the points pointed out by several reviewers. Also I confirmed that it was reflected in the revised manuscript. Despite the limitations of the study, this study contains meaningful data to publish and examines the relationship between low birth weight and oral health. Therefore, it is judged to be suitable for publication.

Reviewer #2: The authors still presented the limited findings by a simple analytical fashion in the revised manuscript. In this retrospective study, readers may be interested in the differences in the potential factors for the poor oral health (as well as dietary habits or fewer dental treatment experiences) between the preterm birth and the full-term birth groups. The authors can use the relevant regression analysis to explore them in the preterm birth and the full-term birth groups, respectively. Why did the authors NOT perform these regression analyses? Please explain it.

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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.

Oral characteristics and dietary habits of preterm children: A retrospective study using National Health Screening Program for Infants and Children

PONE-D-22-19700R2

Dear Dr. Kang,

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,

Kuo-Cherh Huang

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Dr. Kang,

I appreciate your additional work of carrying out multiple variable analysis as requested by the reviewer. I only have some remaining relatively minor suggestions: for the newly added Table 6, since you included an exact p-value column within the table along with a table title indicating “Multivariable logistic regression analysis”, the footnote became redundant, then -- “* Multivariable logistical regression model and Wald test, p<0.05”. On the other hand, Tables 2 and 3 need to add footnotes to be explicit about the analysis approach. Thank you.

Kuo-Cherh Huang

Reviewers' comments: