Comparative Clinical Study on Periodontal Health Status and Early Diagnosis of Periodontal Diseases Quantified through Clinical Periodontal Indices on a Group of Children and Adolescents with and without Cardiovascular Diseases

Round 1

Reviewer 1 Report

Manuscript of considerable interest for the dental sector, requires a major revision before evaluating possible publication.

Abstract: not well described, highlight the results obtained more.

keywords: very generic, insert specific keywords registered on MeSH.

Introduction: the oral microbiota is missing in the developmental age and all the invasive systems to maintain the state of homeostasis of the oral cavity. (Scribante et al)doi.org/10.3390/microorganisms10040675

Materials and methods: the calculation of the sample size is missing.

Very confusing results, graphs not in high resolution, and tables not well decipherable, clearly show the statically significant data.

Discussion: Add the use of probiotics, paraprobiotics and postbiotics for the maintenance of eubiosis as future objectives.

Conclusion: Add proactive action

Bibliography: add required bibliography.

Author Response

Thank you for reviewing the article and for your interest

Abstract: not well described, highlight the results obtained more.

I reorganized the information and described the material and method better.

It is well known that bacterial plaque is the main etiological factor that causes the appearance of periodontal diseases and carious disease. Periodontal diseases can affect children and adolescents, manifested in the form of gingivitis, but also the early form of chronic periodontitis as well as aggressive marginal periodontitis associated with local or general factors. Early periodontitis is frequently undiagnosed by clinicians due to the lack of knowledge of the specific symptoms. Certain systemic diseases, such as cardiovascular diseases, can create favorable conditions for the appearance and progression of severe manifestations of periodontal disease, also, recent research highlights that individuals with periodontal disease would present an increased risk to develop cardiovascular diseases. Children with congenital or acquired cardiovascular diseases are at increased risk for complications resulting from the growth of microorganisms in the oral cavity, presenting a risk of infective endocarditis. The specific aim was to highlight the existing differences between the periodontal health of children with cardiovascular diseases and that of children without these diseases. The analyzed group included a few 124 patients, represented by children and adolescents, aged between 7 and 17 years, who were divided into four subgroups, depending on the presence or absence of cardiovascular diseases and periodontal disease. The specialized clinical examination was performed for each patient, periodontal clinical parameters were quantified (plaque index, gingival bleeding index, gingival index, community periodontal index of treatment needs) and associated with the diagnosis of general condition. Patients diagnosed with periodontal disease underwent specialized treatment and were called to a control visit 3 months after treatment. Statistical analysis showed significant differences between subgroups with much higher values of clinical parameters, for patients with cardiovascular disease. Also, the response to the treatment was better, in the case of patients in the control subgroup, without cardiovascular diseases. The present study highlighted the interaction of three factors in the progression of periodontal diseases: subgingival microbiota, immune system response and environmental factors.

keywords inflammatory condition, periodontal disease; children and teenagers, cardiovascular diseases, plaque index, gingival index, gingival bleeding index, microbiome, predisposing factors, vicious

I described the way of selecting the lots and reorganized the information.

Thank you

Reviewer 2 Report

Dear Authors,

I have read with a lot of interest the manuscript as it focuses on a highly clinical  relevant topic. Early detection of early onset periodontal disease plays a crucial role in providing the optimum treatment, especially in patients with comorbidities such as cardiovascular disease. Finding a correlation between periodontal disease and cardiovascular status of the patients is of great importance as in these particular sensitive patients prevention should be emphasized.

Introduction: The introduction effectively sets the stage by highlighting the significance of the topic. 

Materials and Methods: The methodology section is well-written and well-detailed allowing for reproducibility and clarity in the research approach. In this section it should be clarified the ethical approval for the study as this information is missing. 

In this section it is also mentioned that in the anamnesis it was screened for vicious habits such as smoking and alcohol consumption. Taking into consideration that the studied population is made up of minor children, how was this sensitive point evaluated? Please add additional information.

Results: The results section provides a thorough summary of the findings. The section is well presented with clear visuals and the findings align with the conclusion.

Discussion: The discussion section provides a good synthesis of the findings, but it could benefit from a more explicit and focused discussion of the implications of the findings for practice.

Also the discussion section should focus more on the intervention that was made to correct the vicious habits in the smoking patient group.

Conclusion: The conclusions drawn in this paper are thought-provoking and provide a solid foundation for further research in this domain.

References: The references are well-cited and up-to-date.

In summary, this manuscript stands as a well-researched and thoughtfully presented contribution. The author's insights and recommendations have the potential to guide future research and practical implementation. I  recommend this paper for publication after minor corrections.

Author Response

Thank you very much for the review and positive opinions.

Taking into consideration that the studied population is made up of minor children, how was this sensitive point evaluated? Please add additional information.

When completing the consultation sheet, questions related to vicious habits were added, and the participants answered these questions

Treatments and manipulations performed

Patients from subgroups B and D, as well as their families, were trained on maintaining oral hygiene through the correctness of brushing techniques and the use of oral care aids (dental floss, mouthwash, interdental brushes, mouthwash).

The patients in subgroups A and C were subjected to a periodontal treatment protocol (initial stage) which consisted of: motivation to maintain periodontal health through rigorous oral hygiene instruction (learning the correct brushing techniques and use of oral care aids), descaling supragingival (ultrasonic/manual-where needed), airflow (where necessary), professional brushing to create favorable local conditions for healing and maintaining good gingival health. Recommendation of mouthwashes with chlorhexidine 0.12% for three weeks, for severe forms of gingival inflammation, local applications, in the office, of antiseptic substances (chlorhexidine 0.20%, gel with chlorhexidine 1%, glycosite-gel, gel with metronidazole). For children aged between 7-12 years, professional brushing, carried out in the office, was sufficient to remove the microbial factor from the oral cavity.

For all patients, the bacterial plaque was revealed and professional brushing was performed. Periodontally healthy patients (subgroups B and D) were assessed only at the initial visit, where the diagnosis of periodontal health was established. Patients from the subgroups with gingival-periodontal diseases (subgroups A,C) were examined at the initial visit and three months post-therapy.

In order to quit the vicious habits, the teenagers received information related to their harmful effects and were advised to seek the help of specialists if they want to quit smoking.

The patients' families were also involved in the action to fight against vicious habits

Thank you very much

Round 2

Reviewer 1 Report

The authors have partially modified the manuscript, the required bibliographic references are missing, the rest is ok

Author Response

I modified the abstract and described in more detail the way of working and the results.

Introduction

For the introduction, I reorganized the information and rewrote the current state of knowledge. I reviewed the bibliographic notes.

Materials and method.

I introduced the calculation of sample sizes.

The samples are small in size, but future studies can deepen this introductory direction.

The initial batch of patients consisted of 164 patients, of which 40 patients were excluded, because they did not meet the conditions for inclusion in the batch. The remaining batch was 124 patients. The remaining group consisted of 124 patients, divided into four subgroups: A, B, C, D. For each sublot, the general condition parameters were compared: weight,  height, body mass index(BMI), cardiovascular diagnosis, heredocollateral antecedents of cardiovascular diseases. Epidemiological data were also analyzed such as: age, gender, environment of origin (U/R), vicious habits (YES/NO). For each subgroup, periodontal and oral hygiene indices were recorded, at the time of the initial consultation, marked with T1. In the case of the subgroups diagnosed with periodontal disease, the clinical periodontal parameters were recorded at the time of T1 and 3 months after the application of the specialized treatment, denoted byT2.

The statistical analysis highlighted statistically significant differences, between the analyzed groups, for the general and epidemiological data, presented numerically and graphically. The tables and figures within this section offer a brief summary of how the IP, BOP, IG, DP, and CPITN indices are distributed at the T1 and T2 time points in the conducted study, focusing on the essential features, among the subgroups of the analyzed population

The boxplots shown in figures 7-11 offer a rapid and effective representation of the distribution, spread, symmetry, and skewness of the index values within the different subgroups under various conditions. Moreover, these boxplots enable a direct visual comparison among them in a single chart, helping to identify whether there are significant differences in their central values (mean, median). To enhance the clarity of the data distribution within the boxplot, smal  in the location were introduced for each data point (jitter points).

Thank you for your help.

Round 3

Reviewer 1 Report

Manuscript correctly edited, required references still missing