Impacted Mandibular Third Molar Prevalence and Patterns in a Nigerian Teaching Hospital: A 5-Year Retrospective Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

In the current study, the authors have determined the prevalence and pattern of impacted mandibular third molar with 16 associated pathologies in 469 patients between January 2015 and December 2019. They found that the prevalence of impacted mandibular third molar in the study population was 2.51%; commoners in the 21–29 age group (p<0.001). Mesioangular impaction was the most common. Pericoronitis was the commonest indication for extraction, while periodontal pocket was the commonest associated pathology. I have following concerns, before the MS is ready for publication.

 

Specific comments

 

1.     Line 25 and 26 in abstract is repeated.

2.     Grammatical error in line 183.

3.     Is there any family history of Impaction reported in patients.

4.     Since you have used only patients’ information. Do you have corresponding healthy controls.

5.     Is there any geographical and genetic influence on Molar eruption and Impaction. Authors have reported that under normal circumstances, third molars typically erupt into oral cavity between the ages of 17 to 21. So why authors have not included a broader range for patients age (starting from 17 years or below instead of starting from 20 years). Does pregnancy have an impact on tooth eruption.

6.     As Rural Nigerians adolescents have an earlier age of eruption of third molars. Do you think that exercise (mastication) also plays a critical role in tooth eruption timing.

7.     Was Orthopantomography (OPG) performed in any of the patients included in the study. How many times the included patients have visited the clinic for checking their Impaction problem.

Comments on the Quality of English Language

Please work on the grammar 

Author Response

Response to Open Review 1

Specific comments

 

1. Line 25 and 26 in abstract is repeated.

Response 1: The repeated sentences, “The prevalence of impacted mandibular third molar was low (2.51%). The most common impaction type was mesio-angular impaction” on line 25 and 26 has been deleted.

2. Grammatical error in line 183.

Response 2: The word Sex in has been replaced with “Gender”.

 

3. Is there any family history of Impaction reported in patients.

Response 3: Family history of impaction was not ascertained

 

4. Since you have used only patients’ information. Do you have corresponding healthy controls.

Response 4: Health controls were not used in this study

 

5. Is there any geographical and genetic influence on Molar eruption and Impaction. Authors have reported that under normal circumstances, third molars typically erupt into oral cavity between the ages of 17 to 21. So why authors have not included a broader range for patients age (starting from 17 years or below instead of starting from 20 years). Does pregnancy have an impact on tooth eruption.

Response 5: Age of eruption of the mandibular third molars is between 17-21 years. An impacted tooth is a tooth that has failed to fully erupt into the oral cavity within its expected developmental time period and can no longer be reasonably expected to do so because of lack of space or other impediments. The authors chose a lower limit of 20 years to allow for eruption within the expected developmental time period.

 

6. As Rural Nigerians adolescents have an earlier age of eruption of third molars. Do you think that exercise (mastication) also plays a critical role in tooth eruption timing.

Response: This study did not assess the role of mastication on tooth eruption timing

 

7. Was Orthopantomography (OPG) performed in any of the patients included in the study. How many times the included patients have visited the clinic for checking their Impaction problem.

Response: Orthopantomography was not performed in any of the included patients. All patients had periapical radiographs taken for the assessment of impacted mandibular third molars.

Comments on the Quality of English Language

Please work on the grammar

Response:  An English editor has revised the manuscript

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors,

 

I want to acknowledge the importance of your chosen research topic, as it addresses the prevalence and patterns of impacted mandibular third molars and associated pathologies, which are of significant concern in oral and maxillofacial surgery.

 

However, I must express some concerns regarding the article. While the research topic is essential, the presentation of the study suffers from several issues that need to be addressed to enhance the overall quality and impact of your work.

 

Firstly, the clarity and quality of writing in all sections of the article require significant improvement. The article's structure and flow are not as reader-friendly as they could be, which makes it challenging to follow the research process and findings. Consider revising and simplifying the language to ensure the content is accessible.

 

Secondly, the data analysis methods used in the study need further clarification and review. Specifically, it is unclear how the likelihood ratio was obtained and whether it is the appropriate statistical test for your data. A detailed explanation of the statistical methods used and the rationale behind their selection would significantly enhance the article's scientific rigor and reproducibility.

 

To improve the article, I recommend the following steps:

 

1. Enhance Clarity: Rewrite and restructure the sections of the article to improve clarity and readability. Ensure that the flow of information is logical and coherent.

 

2. Data Analysis: Provide a more comprehensive explanation of the statistical methods used, including the specific calculations for the likelihood ratio. Consider consulting with a statistician to ensure the appropriate statistical tests are applied.

 

3. Discussion of Limitations: Address the limitations of the study and discuss any potential sources of bias or confounding factors that may have influenced the results.

  

I hope that this feedback proves helpful as you revise your manuscript.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

The English, in general, is acceptable. However, there are issues with the style and clarity of presenting the text. For instance, the introduction should ideally consist of three to four paragraphs. Additionally, the discussion section does not address the limitations of the study. The text is challenging to read.

 

 

Author Response

Response to open Review 2

 

Open Review

Dear authors,

 

I want to acknowledge the importance of your chosen research topic, as it addresses the prevalence and patterns of impacted mandibular third molars and associated pathologies, which are of significant concern in oral and maxillofacial surgery.

 

However, I must express some concerns regarding the article. While the research topic is essential, the presentation of the study suffers from several issues that need to be addressed to enhance the overall quality and impact of your work.

 

Firstly, the clarity and quality of writing in all sections of the article require significant improvement. The article's structure and flow are not as reader-friendly as they could be, which makes it challenging to follow the research process and findings. Consider revising and simplifying the language to ensure the content is accessible.

 

Secondly, the data analysis methods used in the study need further clarification and review. Specifically, it is unclear how the likelihood ratio was obtained and whether it is the appropriate statistical test for your data. A detailed explanation of the statistical methods used and the rationale behind their selection would significantly enhance the article's scientific rigor and reproducibility.

 

To improve the article, I recommend the following steps:

 

1. Enhance Clarity: Rewrite and restructure the sections of the article to improve clarity and readability. Ensure that the flow of information is logical and coherent.

 

Response 1: The article has been rewritten and restructured.

 

2. Data Analysis: Provide a more comprehensive explanation of the statistical methods used, including the specific calculations for the likelihood ratio. Consider consulting with a statistician to ensure the appropriate statistical tests are applied.

 

Response 2: The decision to use Likelihood Ratio was guided by the fact that the cross tabulation showed multiple cells with expected counts less than 5. This makes it inappropriate to interpret the result using Chi-square. It also made it expedient to use an alternative to chi-square.

 

It would be either Fisher's exact test (for 2 x 2 tables) or Likelihood Ratio for m x n tables where either m or n is greater than 2. 

This is the explanation for the use of a Likelihood Ratio.

 

3. Discussion of Limitations: Address the limitations of the study and discuss any potential sources of bias or confounding factors that may have influenced the results.

 

Response 2: “The retrospective and the convenient sample design employed in data acquisition may not allow for the generalisation of our findings” (Line 317 and 318)

 

  

I hope that this feedback proves helpful as you revise your manuscript.

peer-review-32311210.v2.pdf

 

Comments on the Quality of English Language

The English, in general, is acceptable. However, there are issues with the style and clarity of presenting the text. For instance, the introduction should ideally consist of three to four paragraphs. Additionally, the discussion section does not address the limitations of the study. The text is challenging to read.

 

Response: The article has been restructured. An English editor was also consulted to enhance the Quality of English Language.

Limitations for the study are stated in line 317 and 318.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

 

Re: Manuscript Review and Recommendations

 

Firstly, I would like to commend you for the effort you have put into the manuscript. It's evident that there has been significant improvement in the text. However, to better tailor the manuscript for publication, I have a few suggestions that I believe will enhance its quality and readability.

 

1. Abstract:

In the abstract, it would be prudent to conclude with a general statement summarizing the overall findings of your work. For example: "The low prevalence reported may be attributed to a potential bias based on the symptomatic presentation of 25 patients and the subsequent need for extraction." It would be beneficial to avoid delving into minute details at this stage.

 

2. Introduction:

Please consider reducing it to three paragraphs. The introduction should serve as a concise review of the broader topic. Instead of delving into extensive details, it should focus on the prevalence of impacted molars, discussing what is currently known, identifying gaps in existing knowledge, and outlining the specific aims of your research. I recommend guiding the reader from established knowledge to uncharted areas, culminating in your research question. It might be beneficial to avoid revealing results or their implications in the introduction. Given the current structure, consider the possibility of omitting paragraphs 3 and 4.

 

3. Results and Discussion:

Please see the attached document for specific comments and suggestions.

 

These modifications will make the manuscript more focused and allow readers to grasp the core of your research quickly. I hope you find these suggestions constructive and helpful for your revision process.

 

Best regards,

Comments for author File: Comments.pdf

Comments on the Quality of English Language

see comments

Author Response

Response to Review

 

1. [M1] Abstract: Please rewrite for clarity

Response 1: Abstract rewritten.

 

2. [M2] Introduction: Please rewrite for clarity. Limit the introduction to three paragraphs

Response 2: Introduction rewritten and limited to three paragraphs

 

3. [M3]: Results: Consider to remove this information. There is anything mentioned either in the results of in the discussion.

Response 3: Information removed.

 

4. [M4] Results: The Likelihood Ratio is a test statistic for the entire table rather than just for one row. Thus, we need to present it in a manner that clarifies it pertains to the table as a whole.

Response 4: Information regarding Likelihood ratio represented.

 

5. [M5]: Please apply for all table.

Response 5: Applied to table as requested.

 

6. All other corrections suggested in the discussion and conclusion have been implemented.

 

7. Limitations and Implications of the study have been added.

Author Response File: Author Response.pdf