PONE-D-24-53777Early Childhood Caries Intervention in Aboriginal Australian Children: follow-up at child age 9 yearsPLOS ONE

Dear Dr. Ju,

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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Yolanda Malele-Kolisa, BDS, MPH, MDent, PhD

Academic Editor

PLOS ONE

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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: Yes

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

Reviewer #1: Yes

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: 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: 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: The study is interesting, but several aspects require clarification.

1. How exactly was "sugar-sweetened beverage (SSB) consumption as a percentage of total food intake" or "percentage of free sugar consumption as a proportion of total energy intake" assessed? Which of these variables was included in the analysis?

2. On what basis was alcohol consumption categorized for women? What threshold was used to assign them an alcohol consumption status?

3. Why do the authors conclude that their study indicates that stopping smoking during pregnancy can reduce the incidence of ECC? The evidence for this statement is unclear.

4. The following sentence is too long and unclear:

"It cannot be denied that the prevalence of missing teeth due to dental caries in the primary dentition was much higher due to early extractions or exfoliation, resulting in premature eruption of permanent teeth, which increased the risk of dental caries in the permanent dentition."

Could the authors clarify this statement? Additionally, why do they suggest that the prevalence of missing teeth due to dental caries is higher due to exfoliation? Naturally exfoliated teeth are not included in the caries index, and severely carious teeth often do not exfoliate naturally.

5. Based on the results of the current study, it is not possible to conclude that "an ECC intervention delivered in early childhood had a long-term effect on reducing dental caries experience in the primary dentition at child age 9 years." There was no control group without intervention, and a comparison with national data alone is insufficient to confirm the intervention's success.

Reviewer #2: This paper is a very valuable report on the effectiveness of early intervention in preventing dental caries in indigenous Australian children up to the age of 9 years.

However, the following points require reconsideration.

The authors have already reported results up to 5 years of age in another journal (ref. 18), and more consideration should be given to the effect on caries in the permanent dentition.

Why is early permanent tooth caries more common in group II?

Why is there more caries in boys in the deciduous dentition but more in girls in the permanent dentition?

Need to explain Model in Tables 2 and 3.

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Reviewer #1: No

Reviewer #2: No

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Early Childhood Caries Intervention in Aboriginal Australian Children: follow-up at child age 9 years

PONE-D-24-53777R1

Dear Dr. Ju,

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,

Yolanda Malele-Kolisa, BDS, MPH, MDent, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for addressing all the comments on the manuscript.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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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: Partly

Reviewer #2: Yes

Reviewer #3: (No Response)

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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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: Yes

Reviewer #3: (No Response)

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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: Yes

Reviewer #3: (No Response)

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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 #1: Both groups received an intervention, so please consider changing the first sentence of the Conclusions to e.g.: "The present study suggests that, within this cohort, initiating an early childhood caries intervention during pregnancy and infancy may be associated with lower caries experience in the primary dentition by age 9 years compared to a later start."

Please also describe limitations, such as the use of a “cumulative” dmft that retains the status of exfoliated teeth previously affected by caries; while this preserves caries history, such an index can complicate interpretation at older ages.

Reviewer #2: The revised version was well improved in line with the reviewer's suggestion.

I think this manuscript should be accepted for publication in Plos One.

Reviewer #3: The study aimed to estimate the efficacy of an Early Childhood Caries (ECC) intervention among Aboriginal Australian children over 9 years, and to explore potential risk factors associated with dental caries among Indigenous Australian children.

It appeared that previous concerns were not of a statistical nature, but were requiring some clarifications which have been addressed. The design and analysis was fairly simple and well presented. Four hundred and forty-eight women pregnant with an Aboriginal child were randomly allocated to either an immediate (II) or delayed (DI) intervention group. There was no formal statistical design calculations for sample size or power in this paper. However, the sample size appeared quite adequate.

Multivariable log-Poisson regression models with robust standard error estimation were applied as a statistical model to estimate multivariable relationships of dental caries and other covariates. Risk ratios (RRs) with 95% CI were calculated. Sensitivity analyses were conducted by using the inverse-probability-of censoring weighting (IPCW) to overcome the loss-follow-up issues. Model building logically involved a hierarchical structure.

The models were appropriately applied and interpreted. The conclusions followed from the analyses performed and were appropriately presented.

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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

Reviewer #3: No

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