Chronic Obstructive Pulmonary Disease and Apical Periodontitis and Other Oral Health Variables: A Case-Control Study

Round 1

Reviewer 1 Report

Dear authors,

the article covers a very interesting topic and I support its publication.

There is a very high self-citation tendency, but most of them are pertinent.

I suggest some changes in order to improve the overall quality of the manuscript for the readers.

 

1. The readers would benefit from a reorganization in the abstract’s structure (even if not mandatory). I suggest to structure it in the following sections:

Objectives, Materials and Methods, Results, Conclusions, Clinical Significance.

 

1. The readers could also find interesting a section (either in the Introduction or in the discussion), a paragraph that relates COPD, periodontopathic bacteria and COVID-19.

Adding a paragraph like the following could be useful to support this concept:

 

“It has been hypothesized that periodontopathic bacteria are also involved in the COVID-19 aggravation and therefore, the management of good oral hygiene potentially contributes to its prevention.”

The following references could support this paragraph:

Takahashi Y, Watanabe N, Kamio N, Kobayashi R, Iinuma T, Imai K. Aspiration of periodontopathic bacteria due to poor oral hygiene potentially contributes to the aggravation of COVID-19. J Oral Sci. 2020 Dec 23;63(1):1-3. doi: 10.2334/josnusd.20-0388. Epub 2020 Nov 12. PMID: 33177276.

 

Paolone G, Mazzitelli C, Formiga S, Kaitsas F, Breschi L, Mazzoni A, Tete G, Polizzi E, Gherlone E, Cantatore G. 1 year impact of COVID-19 pandemic on Italian dental professionals: a cross-sectional survey. Minerva Dent Oral Sci. 2021 Dec 1. doi: 10.23736/S2724-6329.21.04632-5. Epub ahead of print. PMID: 34851068.

 

Dentistry and Covid-19 pandemic: operative indications post-lockdown.

Gherlone E, Polizzi E, Tetè G, Capparè P.New Microbiol. 2021 Jan;44(1):1-11. Epub 2020

Oct 31.PMID: 33135082

 

1. Please add limitations of this study, on the study design and possible future improvements of the methodology

Author Response

Thank you very much for your comments, I enclose the answers in podf format

José López

Author Response File: Author Response.pdf

Reviewer 2 Report

Dear Authors,

This paper addresses an interesting topic, however, I would recommend several modifications before considering its publication. Below these are some suggestions for You:

1. Introduction:

It does not provide sufficient background - I suggest to place all definitions in material and methods. The aim of the introduction is as follows: ‘The introduction should briefly place the study in a broad context and highlight why it is important’. 

Second, PAI should be presented entirely - every single score should be named. Another matter is the definition of periodontal diseases - do you focus on classic periodontitis or (peri)apical periodontitis of endodontic origin? Maybe 1.3 and 1.1. should be merged. 

2. Material and methods: 

Here definitions should be placed. 

Despite this, it is quite well organized and presented. 

3. Discussion: 

I suggest renaming subsections, using not abbreviations, but full words, please. 

Good for you, limitations are discussed, especially panoramic radiography. 

4. References:

The article is well documented with a vast number of references.

 

Best regards and good luck

Author Response

Thank you very much for your comments, I enclose the answers in podf format.

José López

Author Response File: Author Response.pdf

Reviewer 3 Report

Dear Authors,

Thank you for submitting your valuable work to the journal. During the Covid-19 pandemic, pulmonary diseases have seen a dramatic increase in prevalence in patients, often with life-threatening consequences. Thus, the subject of your research is actual and intersting, assessing the possible risk factor of apical inflammatory reaction in the development of COPD. However, there are some comments that I would make in order to increase the paper's scientific accuracy.

- Introduction: Apical Periodontitis is not included in the Classification of Peridontal Diseases, hence its different pathogenesis. I think the inclusion of information about periodontal diseases is misleading and confusing for the reader, and thus should be removed

- 1.6: The connection between COPD and peridontal diseases is irrelevant in this case, as once again, Apical Periodontitis and Periodontitis are two distinct type of diseases, with different pathogeny, diagnostic and treatment. These connections may however be used in the Discussion section, for comparison to Apical Periodontitis

-1.7: justification should be rephrased to a more formal style, Objectives should be rephrased for increased clarity

- Materials and Method: points 2.4 2.5 2.6 are unclear and include too much information, they should be rephrased and simplified

- Discussion: more should be elaborated and discussed on the overall significance of the results and not so much on individual points and variables

We look forward to receive the revised version of your manuscript.

Kind regards!

 

 

Author Response

Thank you very much for your comments, I enclose the answers in pdf format.

José López

Author Response File: Author Response.pdf

Reviewer 4 Report

 The article is well structured and the research is conducted in accordance with scientific requirements. I appreciated the idea of the authors, it is an interesting study and I think it can be a starting point for other research in this direction.   

 

In my opinion, there are a number of concerns that should be handled better.I also have some questions/recommendations to clarify some of the authors' less-emphasized points.

 

1.      The title specifies only periapical periodontitis, however,  the article presented results related to No of caries, Matilla Index, Klemetti index, Stage of periodontis, e.a. Please find a formula so that the title is more general about dental and periodontal diseases.

2.      As you recognize, you have many variables that cannot be controlled-Diabetus mellitus, the cronical medication, oral hygiene at this age is sometimes difficult to do due to physical limitations . Do you think that these variables do not influence the final result?

3.      In my opinion in the results chapter, you have also described the material and method (3.1, 3.2) which should be in the subchapter 2.

4.      Please double-check the bibliographic references and correct any that do not follow the recommended format.

5.      Are you thinking of continuing your research and if so, in what way?

 

Author Response

Thank you very much for your comments, I enclose the answers in pdf format.

José López

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Dear Authors,

This is a revised version of your original manuscript. You have corrected it according to the suggestions and it can be accepted without any changes now. 

Best regards

Reviewer 3 Report

Dear Authors,

Thank you for submitting your revised version in a short time, your work has been great. You have addressed all comments accordingly, I have no further suggestions. 

 

Kind regards

Reviewer 4 Report

I have verified the requested changes. The authors have met the requirements, therefore I agree with the publication in this form.