Untreated Early Childhood Caries and Possible Links with Brain Development

Round 1

Reviewer 1 Report

The authors describe potential links between brain development and ECC and its consequences or concomitants.  In particular, the topics of occlusion & mastication, inflammation, sleep disturbances and pharyngeal microbiome are described in detail. Thus, the work makes an important contribution to the complex understanding of the consequences of ECC. The paper is not based on original research. The authors cite a large number of literature references - giving the impression that a comprehensive literature search has taken place. However, no search and evaluation strategy was described in the paper. Consequently, it is not possible to assess the scientific reliability of the manuscript. It cannot be excluded that only those literature passages were cited that support the authors' assumptions.

The topic is very interesting and it would be desirable that the authors consider the question of the influence of ECC and its concomitants on brain development in children in the context of a systematic literature review. Alternatively, at least the methodology of selecting the literature references should be described in more detail.

Good English Language - text is well written. 

Author Response

The authors describe potential links between brain development and ECC and its consequences or concomitants.  In particular, the topics of occlusion & mastication, inflammation, sleep disturbances and pharyngeal microbiome are described in detail. Thus, the work makes an important contribution to the complex understanding of the consequences of ECC.

• Response: Thanks for the feedback

The paper is not based on original research. The authors cite a large number of literature references - giving the impression that a comprehensive literature search has taken place. However, no search and evaluation strategy was described in the paper. Consequently, it is not possible to assess the scientific reliability of the manuscript. It cannot be excluded that only those literature passages were cited that support the authors' assumptions.

• Response: As indicated on submission, this was an opinion piece. Based on this, the team are working on a scoping review to map the literature on the subject matter. We hope our position that is this an opinion piece is the basis for the team to develop the conceptual framework for the scoping review and our first basic laboratory and morbid anatomy exploratory studies by the research group. We have included a paragraph as a limitation and wrote: This opinion piece has its limitations. We acknowledge that this was a consensus review that drew on our expert knowledge of the subject matter, and the evaluation of research to reach our collective conclusions. However, the main weakness lies in the potential for bias during article selection as we may select articles that confirm own views, and thereby, unintentionally introduce bias. The information aligns better with the specifics of the focus of our discussion, and potentially offers more relevant guidance for further work on the topic of interest. There are no established standards or guidelines governing the process of generating articles for an opinion piece and so we share some insights into the issue understanding that our thorough grasp of the overall state of the science concerning the problem is limited and further studies are needed. The group will build on the conceptual framework from this study to inform our future studies.

The topic is very interesting and it would be desirable that the authors consider the question of the influence of ECC and its concomitants on brain development in children in the context of a systematic literature review. Alternatively, at least the methodology of selecting the literature references should be described in more detail.

• Thanks a million. As noted, this framework helps to develop our conceptual framework for the next phase of research by the research group.

Author Response File: Author Response.pdf

Reviewer 2 Report

This is a well written review on the possible link between childhood caries and brain development. Caries is a potential (indirect) factor. The review points too strong to the potential link, but when this is weakened in the body of the text and in the conclusion, the paper is a valid contribution to the existing literature.  

Author Response

This is a well written review on the possible link between childhood caries and brain development. Caries is a potential (indirect) factor. The review points too strong to the potential link, but when this is weakened in the body of the text and in the conclusion, the paper is a valid contribution to the existing literature.  

• Response: thanks for the constructive feedback. We have tried to strengthen the paper by acknowledging the limitation of the piece. We wrote: This opinion piece has its limitations. We acknowledge that this was a consensus review that drew on our expert knowledge of the subject matter, and the evaluation of research to reach our collective conclusions. However, the main weakness lies in the potential for bias during article selection as we may select articles that confirm own views, and thereby, unintentionally introduce bias. The information aligns better with the specifics of the focus of our discussion, and potentially offers more relevant guidance for further work on the topic of interest. There are no established standards or guidelines governing the process of generating articles for an opinion piece and so we share some insights into the issue understanding that our thorough grasp of the overall state of the science concerning the problem is limited and further studies are needed. The group will build on the conceptual framework from this study to inform our future studies.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The added explanations regarding the literature selection process and potential biasing is satisfying.

Thank you and good luck for your review!