-->PONE-D-24-23202-->-->Prevalence of Dental Caries in the Primary, Mixed and Permanent Dentitions in Nigeria: A Systematic Review and Meta-analysis-->-->PLOS ONE

Dear Dr. Akinsolu,

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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We look forward to receiving your revised manuscript.

Kind regards,

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

Academic Editor

PLOS ONE

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2. Thank you for stating the following financial disclosure: "Grant Number: 5NM-ADJGT-22-0082 from the Nigerian Institute for Medical Research"

Please state what role the funders took in the study.  If the funders had no role, please state: ""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 :

The Systematic Review requires major revision. Systematic reviews provide the best available evidence to change and influence policy and practice. The following methodology changes are proposed:

1. The search words used for review should be specified.

2. Specify Data Synthesis process

3. Research question highlighting the phenomenon of interest, population, outcome measure in addition to the stated language, study types etc.

4. For statistical pooling, specify the justification for using the random effect model.

5. Address the Reviewer comments

[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: Partly

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

Reviewer #1: No

**********

-->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

**********

-->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

**********

-->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: CORRECTION OF THE MANUSCRIPT (PONE-D-24-23202)

PLOS ONE

I am submitting my comments regarding the manuscript titled "Prevalence of Dental Caries in the Primary, Mixed and Permanent Dentitions in Nigeria: A Systematic Review and Meta-analysis." The study is a systematic review of prevalence aimed at identifying the prevalence of dental caries in Nigeria across deciduous, mixed, and permanent dentitions. I believe this study is significant. However, I list some concerns that should be considered by the authors.

In the introduction, there is a need for a better justification of the study's publication. What is its importance to the scientific community? How does it benefit the population of Nigeria? Have other countries conducted similar analyses?

In the methodology, please include the research question and the acronym used to outline the study. To assess bias risk, I suggest using the Joanna Briggs Institute's tool. Additionally, I recommend using the GRADE checklist to assess the certainty of evidence.

In the results, the authors identify extreme prevalence percentages. These data should be interpreted cautiously considering the certainty of evidence from the included studies.

In the discussion, I suggest including the strengths and limitations of the study towards the end of this section. Additionally, all discussed points need to be referenced.

Decision: major review

**********

-->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

**********

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Attachments

Attachment

Submitted filename: Reviewer PONE.docx

-->PONE-D-24-23202R1-->-->Prevalence of Dental Caries in the Primary, Mixed and Permanent Dentitions in Nigeria: A Systematic Review and Meta-analysis-->-->PLOS ONE

Dear Dr. Akinsolu,

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 29 2025 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,

Ashish Wasudeo Khobragade, MD

Academic Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Additional Editor Comments:

1. The % symbol is repeated in each row in Table 3 under the column ‘Prevalence of dental caries’.

2. Please provide high-resolution figures. Most of the figures are blurred and not clearly visible.

3. Comment on the publication bias considering the funnel plot. Provide the results of Egger’s test or Begg and Mazumdar’s test.

4. Studies included in the metanalysis from 2001 to 2023. The prevalence of dental caries varies over the years. How may this affect the pooled prevalence? Provide meta-regression findings.

5. How the sensitivity analysis was conducted, and mention the findings.

[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 #2: (No Response)

Reviewer #3: (No Response)

Reviewer #4: (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 #2: (No Response)

Reviewer #3: Partly

Reviewer #4: Yes

**********

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

Reviewer #2: (No Response)

Reviewer #3: Yes

Reviewer #4: 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 #2: (No Response)

Reviewer #3: Yes

Reviewer #4: 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 #2: (No Response)

Reviewer #3: No

Reviewer #4: 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 #2: (No Response)

Reviewer #3: The manuscript presents a systematic review and meta-analysis aimed at determining the prevalence of dental caries in primary, mixed, and permanent dentitions among residents in urban, rural, and semi-urban Nigeria. I think this manuscript is poorly written in many ways, including grammar, English usage, etc., and it cannot be published in this format. The comments are as follows:

1.There are many long sentences that are not easy to understand. The English is weak and should be edited. Some parts are not completely clear. Even the fonts and formatting are not consistent (e.g., L69).

2.The search dates are not consistent. In the abstract (L51), the dates are between 2005 and 2022. In the “Search Strategy and Selection of Studies” section, the dates are between January 2001 and December 2023 (L130).

3.It is necessary to rewrite the discussion by mentioning the important results of the work, quantitatively.

4.Please double-check the reference list and make the formatting consistent.

Reviewer #4: Thank you for the opportunity to review this manuscript. I have some comments which I hope will help improve it.

1. In my opinion, it would be interesting to study the possible evolution of caries prevalence over time. To do this, I suggest two approaches.

1.1. One way to assess the evolution of the effect size (in this case, prevalence) is ordering the studies in the forest plot (Figure 2, at least) in a chronological manner, to visually assess the evolution.

1.2. An alternative would be, of course, performing a meta-regression with the study year as the predictor and see what happens.

2. Figure 9 contains a funnel plot to assess the publication bias. The manuscript says that the studies included are generally precise, but the purpose of the funnel plot is not only that, but also assess publication bias. I think some bias is visible, because for less precise studies only higher prevalences are shown. The funnel plot should be symetrical to show an absence of publication bias, and I do not think that is the case. Anyway, an Egger's test should clarify the question.

3. In the discussion it is said that there are differences between dentition modes, but the confidence intervals obtained overlap in all cases. Same thing happens with the differences between rural and urban areas.

4. The manuscrips points out as a limitation that two authors authored roughly 20% of the studies, which may be a source of bias. I agree. To account for that, I suggest performing a three-level meta-analysis model, adding a level with clusters of studies performed by the same authors. Perhaps this tutorial (10.20982/tqmp.12.3.p154) may be helpful.

**********

-->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: No

Reviewer #4: No

**********

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

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

-->PONE-D-24-23202R2-->-->Prevalence of Dental Caries in the Primary, Mixed and Permanent Dentitions in Nigeria: A Systematic Review and Meta-analysis-->-->PLOS One

Dear Dr. Akinsolu,

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 May 27 2026 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 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.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only the individual author can complete the verification step; PLOS staff cannot verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Ashish Wasudeo Khobragade, MD

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Additional Editor Comments:

1. Cohort studies are included in the analysis. The objective is to determine the prevalence of dental caries in the primary, mixed, and permanent dentitions.

2. Recheck the extracted values of prevalence and sample size of all studies included in the meta-analysis.

[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 #2: (No Response)

Reviewer #4: 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 #2: (No Response)

Reviewer #4: Yes

**********

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

Reviewer #2: (No Response)

Reviewer #4: 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 #2: (No Response)

Reviewer #4: 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 #2: (No Response)

Reviewer #4: 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 #2: (No Response)

Reviewer #4: (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 #2: No

Reviewer #4: 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.]

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Prevalence of Dental Caries in the Primary, Mixed and Permanent Dentitions in Nigeria: A Systematic Review and Meta-analysis

PONE-D-24-23202R3

Dear Dr. Akinsolu,

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,

Ashish Wasudeo Khobragade, MD

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments: