The Relationship between Pulse Pressure and Periodontal Disease in Korean Populations with or without Hypertension

Round 1

Reviewer 1 Report

The manuscript from Yoon and colleagues aims to assess the correlation between pulse pressure and periodontal disease. Despite the theme has been already deepened in current literature, the work is well written and well organized. Therefore, the manuscript seems to deserve the publication since it fits and complies with Applied Science sound depth.

Author Response

Reviewer(s)' Comments to Author:

Reviewer: 1

Comments to the Author

The manuscript from Yoon and colleagues aims to assess the correlation between pulse pressure and periodontal disease. Despite the theme has been already deepened in current literature, the work is well written and well organized. Therefore, the manuscript seems to deserve the publication since it fits and complies with Applied Science sound depth.

“Thank you very much for your review to improve the quality of our manuscript”

Author Response File: Author Response.docx

Reviewer 2 Report

The manuscript tries to describe the association between pulse pressure and periodontal disease in Korean adults with (n=1,081) or without (n=2,415) hypertension. The authors concluded that the pulse pressure was positively associated with periodontal diseases in hypertension group but not in non-hypertension group in Korean adults.

[Suggestions]
P. 5, L. 3-8, and Supplementary table 1:

Is it possible for the authors to describe/draw the area under the curves in (a) Figure(s)?

Table 2:

The authors need to check the style of the Table 2, because the referee is unable to see the Table 2 properly.

Author Response

Reviewer(s)' Comments to Author:

Reviewer: 2

Comments to the Author

The manuscript tries to describe the association between pulse pressure and periodontal disease in Korean adults with (n=1,081) or without (n=2,415) hypertension. The authors concluded that the pulse pressure was positively associated with periodontal diseases in hypertension group but not in non-hypertension group in Korean adults.

“Thank you very much for your review to improve the quality of our manuscript”

1. P. 5, L. 3-8, and Supplementary table 1: Is it possible for the authors to describe/draw the area under the curves in (a) Figure(s)?

Response: The ROC curve is as follows; however, we didn't add Figure to the manuscript because the table has values.

1. Receiver-operating characteristic curve analysis for SBP, DBP, and PP associated with the prevalence of periodontal disease in overall population

 

민감도, Sensitivity; 1-특이도, 1- Specificity; 참조선, Reference

2. Receiver-operating characteristic curve analysis for SBP, DBP, and PP associated with the prevalence of periodontal disease in non-HTN group

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3. Receiver-operating characteristic curve analysis for SBP, DBP, and PP associated with the prevalence of periodontal disease in HTN group

 

2. Table 2: The authors need to check the style of the Table 2, because the referee is unable to see the Table 2 properly.

Response: We have adjusted the orientation of the paper in Table 2 to landscape based on your review.

Author Response File: Author Response.docx

Reviewer 3 Report

 This study performed an evaluation of the association between pulse pressure (PP) and periodontal disease in Korean adults. It provides a further understanding of the PP and periodontal disease in a specific cohort. Comprehensive statistical evaluations are performed to support the conclusion that periodontal disease was positively associated with PP in HTN group but not in non-HTN group. However, there are some concerns remains.

1. It is noticed that in the non-HTN group, only 3% subjects are high PP. The smaller sample size would limit the statistical power. Is it possible that PP is not associated with periodontal disease due to that the study group didn't have enough power to detect the association? A power analysis of the samples size is necessary.
2. Between PP and SBP, which shows a stronger association with periodontal disease among HTN group? The SBP shows a higher level in periodontal disease group among HTN. However, it is not adjusted in the comparison of CPI and high PP. It could not exclude the possibility that it is SBP instead of PP associated periodontal disease. Base on the analysis and discussion, the association of PP and periodontal disease is more likely a result of high SBP.
3. Table 2 is not displayed correctly. Only partial contents are available.

Author Response

Reviewer(s)' Comments to Author:

Reviewer: 3

Comments to the Author

This study performed an evaluation of the association between pulse pressure (PP) and periodontal disease in Korean adults. It provides a further understanding of the PP and periodontal disease in a specific cohort. Comprehensive statistical evaluations are performed to support the conclusion that periodontal disease was positively associated with PP in HTN group but not in non-HTN group. However, there are some concerns remains.

“Thank you very much for your review to improve the quality of our manuscript”

 

1. It is noticed that in the non-HTN group, only 3% subjects are high PP. The smaller sample size would limit the statistical power. Is it possible that PP is not associated with periodontal disease due to that the study group didn't have enough power to detect the association? A power analysis of the samples size is necessary.

Response: We agree with your opinion. This results may be statistically limited as the prevalence of high PP in non-HTNs was only 3%. Therefore, we performed a linear regression analysis on the CPI scores. Also, to confirm the accuracy or usefulness of PP for periodontal disease in non-HTN and HTN groups, receiver operating characteristic curve analysis was performed (Supplementary Table 1).

 

2. Between PP and SBP, which shows a stronger association with periodontal disease among HTN group? The SBP shows a higher level in periodontal disease group among HTN. However, it is not adjusted in the comparison of CPI and high PP. It could not exclude the possibility that it is SBP instead of PP associated periodontal disease. Base on the analysis and discussion, the association of PP and periodontal disease is more likely a result of high SBP.

Response: We agree with your opinion.

PP is known as a predictor of left ventricular hypertrophy and PP level was calculated as SBP minus DBP. In fact, many previous papers have been reported that increasing SBP affects left ventricular hypertrophy more than decreasing DBP. Since PP is the difference between SBP and DBP, an increase in SBP can strong contribute to an increase in PP.

In addition, in the logistic regression analysis of PP and periodontal disease and the adjustment for SBP or DBP was excluded from the correction variable because it is a double adjustment.

 

3. Table 2 is not displayed correctly. Only partial contents are available.

Response: We have adjusted the orientation of the paper in Table 2 to landscape based on your review.

Author Response File: Author Response.docx

Reviewer 4 Report

The title of the manuscript is appropriate and indicative of the material, which is contained in the manuscript. The abstract is formulated upon all the criteria of the journal and describes clearly the purpose, materials, methods, results and the conclusions. 

The introduction is clearly formulated, complete and very detailed. There is a clear statement of the objectives of the study. Material and Methods used in the study scientifically valid and technically are correct. The procedures are clearly presented. There is no plagiarism in the article. The statistical analysis is complete, the author describes in a correct way the found result. The results and data gathered in the study are presented in a clear and logical method. The discussion is concisely stated. It develops arguments and theories from evidence. The conclusion is clear, concisely presented and based on the results of the study and on the statistical analysis. In my opinion the article should be accepted.

Author Response

Reviewer(s)' Comments to Author:

Reviewer: 4

Comments to the Author

The title of the manuscript is appropriate and indicative of the material, which is contained in the manuscript. The abstract is formulated upon all the criteria of the journal and describes clearly the purpose, materials, methods, results and the conclusions. The introduction is clearly formulated, complete and very detailed. There is a clear statement of the objectives of the study. Material and Methods used in the study scientifically valid and technically are correct. The procedures are clearly presented. There is no plagiarism in the article. The statistical analysis is complete, the author describes in a correct way the found result. The results and data gathered in the study are presented in a clear and logical method. The discussion is concisely stated. It develops arguments and theories from evidence. The conclusion is clear, concisely presented and based on the results of the study and on the statistical analysis. In my opinion the article should be accepted

“Thank you very much for your review to improve the quality of our manuscript”

Author Response File: Author Response.docx