PONE-D-23-10589Association between gastroesophageal reflux disease and dental caries among adults in the Azar cohort population: A cross-sectional studyPLOS ONE

Dear Dr. Mahboobi,

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.

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Hadi Ghasemi

Academic Editor

PLOS ONE

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2. Thank you for stating the following financial disclosure:

“The author(s) received no specific funding for this work.

Data used in the present study was obtained from the database of the Azar Cohort study. The Azar cohort study was supported by the liver and gastrointestinal diseases research center (Grant number 700/108 on 14 March 2016) at Tabriz University of Medical Sciences. The Iranian Ministry of Health and Medical Education has contributed to the funding used in the PERSIAN cohort through Grant no.700/534. The funders had no role in the study design, data analysis, interpretation, and writing the manuscript in this study.“

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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: No

Reviewer #2: Partly

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

Reviewer #1: No

Reviewer #2: 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: No

Reviewer #2: No

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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: No

Reviewer #2: 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: Thank you for asking me to review the manuscript titled “Association between gastroesophageal reflux disease and dental caries among adults in the Azar cohort population. A cross-sectional study”

The article is relevant to the field of Internal medicine and Dentistry. However, there are flaws in the write -up;

Introduction

A major drawback of this manuscript is that the authors failed to review literature on GERD and dental caries. In addition, they didn’t identify any gap/s in literature that their study would want to address.

Generally, the paragraphs don’t flow into each other – the previous paragraph doesn’t flow to the next.

Methods

In addition to other confounding variables, the authors should have considered the oral hygiene status of the participants.

Similarly, there is no information on the fluoride exposure of the participants in the study.

Although information on free sugar consumption was obtained, the frequency of free sugar consumption between meals will be more appropriate in relation to caries formation.

Classification of GERD frequency of regurgitation should be referenced

Results

It would have been better to compare the mean DMFT scores of both groups based on the different variables (socio-demographic, oral health practices and BMI) before the regression analysis.

Discussion

This is inadequate- the authors didn’t discuss the reasons behind their findings

Reviewer #2: Title: It is limited, as there are many other factors that have been checked other than GERD. So you need to modify your title accordingly.

Abstract:

- Objectives: There are many other objectives that were not mentioned.

- Materials and methods: very confusing, as I don’t understand if all your data obtained from dataset

previously recorded, Or the clinical examination and the interviews were conducted as part of this

study. This same comment is applied to methodology section that needs to be re-written.

Introduction:

Line 53: move word ‘still’ after ‘are’.

Line 60: consistency in writing word ‘socioeconomic’.

Next to first paragraph, additional paragraph should be added to briefly preset the socioeconomic and environmental factors that is related or may affect dental caries.

Line 78: Add reference.

Add null hypothesis to the last paragraph

Methods:

-Very confusing as mentioned previously, which data that have been obtained from previous records and which data were obtained by clinical examination and questionnaires in this study??

-And if questionnaires were used, you have to specify is it online , face to face interview, paper based?

-What was the response rate in each questionnaire, number of items in each questionnaire, how these items were validated, any piloting for the questionnaire was done?

-Why 905 were selected from 2010 patients with GERD, and how these patients were selected.

-GERD patients only were diagnosed based on the two questions that have been mentioned.

- What do you mean by oral examiner, this is not acceptable description.

- Variables and data measurement section is not clear and more details should be added.

- Line 134-136: What are the categories?

Tables:

-Wealth index: what are the ranges of poor, moderate ….by numbers?

- Footnotes should be added to your tables

-

Discussion:

Line 202: Add few studies as you have mentioned in the text.

Line 208, 209: rephrase the sentence using DMFT term.

Line 223: Add reference

Line 231: Reference 33, 34 are irrelevant

Line 242: Discuss further regarding developing country and provide reference.

Line 253: Few studies… (however one reference was mentioned)

Line 258: Add reference

Line 258-260: The discussion is weak regarding the tobacco consumption

Discussion section needs improvement and more details and justifications for your findings should be presentd.

General comments:

English language needs to be checked.

It is nice to see at least one figure.

References need to be checked as many sentences need referencing, and some references are not really relevant to the text.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: review.docx

PONE-D-23-10589R1Association between gastroesophageal reflux disease and dental caries among adults in the Azar cohort population: A cross-sectional studyPLOS ONE

Dear Dr. Mahboobi,

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 Aug 24 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,

Hadi Ghasemi

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.

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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 #2: (No Response)

Reviewer #3: All comments have been addressed

Reviewer #4: (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 #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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 #2: No

Reviewer #3: Yes

Reviewer #4: 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 #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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 #2: Thank you for addressing all comments, few comments were added to the revised manuscript itself. Thank you

Reviewer #3: All comments by previous reviewer have been addressed adequately. The methods have been addressed comprehensively, the discussion has been improved upon. Also the English has been adequately corrected. This new reviewed article makes a better read.

Reviewer #4: General Comments:

The paper "Association between gastroesophageal reflux disease and dental caries among adults in the Azar cohort population: A cross-sectional study" presents a study that looked at the relationship between GERD and dental caries using the DMFT index. The study investigates potential confounding variables and gives a thorough analysis of the findings. Overall, the work is well-written and structured, and it contributes significantly to the subject of dentistry. While some small edits and clarifications are needed, the manuscript gives a compelling research study with relevant findings.

Specific Comments:

Introduction:

The introduction gives a clear context and rationale for the research. Given that tooth erosion is a prevalent issue in GERD patients, it effectively emphasizes the necessity of knowing the relationship between GERD and dental caries. The introduction also discusses the existing literature gap about the relationship between GERD and dental caries. However, at the end of the introductory section, a more clear and focused statement of the study's aims would be beneficial with clear hypothesis.

Methods:

The methods section discusses the study's design, participant selection, and data collection procedures in detail. Given its widespread usage in dentistry research, the use of the DMFT index as a measure of dental caries is justified. However, some small clarifications are required. For example, more information on how GERD was assessed, such as the questions or criteria utilized in the questionnaire, would be beneficial. The limitations of self-reported data, as well as their potential impact on the study's conclusions, should also be addressed.

Results:

The results section is well-organized and presents the study's findings clearly. The statistical analysis, including regression analysis, strengthens the study. However, for significant findings, it would be beneficial to provide the effect sizes to provide a better understanding of the magnitude of the associations observed.

Discussion:

The discussion section explores the study's findings in depth in relation to previous studies, noting both consistent and contradictory findings. The discussion is enriched by the inclusion of numerous aspects that may contribute to the association between GERD and dental caries, such as salivary flow, swallowing difficulty, and oral hygiene behaviors. However, a more extensive examination of the potential processes behind the observed relationships, particularly those related to the decline in cariogenic bacteria despite lower saliva quality and quantity, would be beneficial. Furthermore, the study's limitations, such as its cross-sectional design and dependence on self-reporting, are noted correctly. The conclusion emphasizes the need for additional research, which is appropriate.

Language and Structure:

The manuscript is generally well-written with clear and concise language.

Figures and Tables:

The figures and tables provided in the manuscript are relevant and contribute to the understanding of the results.

Overall, the manuscript makes an important contribution to the field of dentistry by exploring the relationship between GERD and dental caries. The study is well-designed, and the results are effectively presented and analyzed.

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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 #2: No

Reviewer #3: Yes: ADEBAYO PETER Adewuyi

Reviewer #4: Yes: Furqan Ahmed

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[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.

Attachments

Attachment

Submitted filename: Revised Manuscript with Trachchanges-Mahboobi NS.doc

Association between gastroesophageal reflux disease and dental caries among adults in the Azar cohort population: A cross-sectional study

PONE-D-23-10589R2

Dear Dr. Zeinab Mahboobi,

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.

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Kind regards,

Hadi Ghasemi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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