Title: EFFECTS OF FIXED AND REMOVABLE SPACE MAINTAINERS ON HALITOSIS

Transcription

1 Author s response to reviews Title: EFFECTS OF FIXED AND REMOVABLE SPACE MAINTAINERS ON HALITOSIS Authors: Elif Yıldızer Keriş (dtelifkaya@gmail.com) didem atabek (dtdidem@hotmail.com) kahraman gungor (kahramangungor@gmail.com) Version: 1 Date: 10 Sep 2016 Author s response to reviews: Responses to the comments of Reviewer #1 1. From the background, it seems to be necessary a brief and better description of correlation of organoleptic and instrumental haliotis measurements. Response: We described the correlation of organoleptic and instrumental halitosis measurements according to your comments and showed in highlighted font in in Background/ Page 4, lines 27-46; The three main methods for measuring and assessing the halitosis are organoleptic measurement, gas chromatography, and sulfide monitoring. In organoleptic method, the physician is smelling the exhaled air of mouth and nose while the patient is breathing and speaking and halitosis is assessed using a score of 0-5. Organoleptic assessment is considered as a suitable method for detecting halitosis but has some disadvantages such as being subjective (13). Gas chromatography and portable sulfide monitor have been developed to evaluate halitosis objectively. Methyl mercaptan, hydrogen sulfide, butyric acid, proprionic acid and valeric acid are called as volatile sulphur components (VSCs) and these components are major cause of halitosis (14). These components are occured as a result of the anaerobic bacteria by metabolizing different cells/ tissues located in the mouth (14-15). Portable sulphur monitors (Halimeters) and gas chromatography measure the total concentration of sulphur compounds. 2. Perhaps these considerations in item 1 could be best described in discussion. I would suggest some information derived from the reference: Schweiz Monatsschr Zahnmed Vol /2010.

2 Response: We discussed the correlation of organoleptic and instrumental halitosis measurements according to your suggestions and obtained information from the manuscript which was published in Schweiz Monatsschr Zahnmed Vol /2010. Revisions were made in Discussion/ Page 10, lines and References; The organoleptic assessment is preferable for the daily practice for diagnosis of bad breath because it is simple to perform and does not require a device. But organoleptic method has some advantages such as not being reproducible, having crossinfection risks and can be affected by the examiner (36-38). It has been reported that gas chromatography is reliable, objective and reproducible method for detecting halitosis (39). However, these devices are complex, not portable and expensive, requires the user s experience (40). In order to overcome these practical drawbacks, portable sulphur monitors (Halimeters) is preferred for routine use in the dental clinic. The Halimeter does not need experienced personnel and easy to perform (39). But Halimeter can only measure the VSCs, the organoleptic method is superior for assessing halitosis caused by non-sulphide components (13). However, recent studies have concluded that the recorded data of Halimeter is correlated with the data of organoleptic method for diagnosing halitosis (41). REFERENCES.41- Brunner F, Kurmann M, Filippi A. The Correlation of Organoleptic and Instrumental Halitosis Measurement. Schweiz Monatsschr Zahnmed 2010;120: The four parameters indexes described on clinical evolution could be well recorded with different grades on table (Miyazaki tongue coating index, plaque index, gingival index, periodontal screening index). The table used to be self-explanatory. Response: We made the changes according to your comments in Table 1; Fixed applience group T1 T2 T3 PI (Plaque Index) Grade 0: No plaque Grade 1: Not visible thin coating of plaque which is only visible after using the probe

3 Grade 2: Moderate accumulation of plaque, visible with the naked eye, but not filling interdental space Grade 3: Abundance of plaque, filling interdental space GI (Gingival Index) Grade 0: No inflammation Grade 1: Mild inflammation, slight change in color, slight edema, no bleeding on probing Grade 2: Moderate inflammation, moderate glazing, redness, bleeding on probing Grade 3: Marked redness and edema, ulceration with tendency to spontaneous bleeding PSI (Periodontal Screening Index) Grade 0: No bleeding on probing, no pathologic pocket, no calculus Grade 1: Bleeding on probing up to 1 mm Grade 2: Calculus and no pathologic pocket Grade 3: Probing depth mm Grade 4: Probing depth > 5.5 mm TCI (Tongue Coating Index) Grade 0: No visible coating Grade 1: Less than a third of tongue dorsum is covered Grade 2: Less than two thirds of tongue dorsum is covered Grade 3: More than two thirds of tongue dorsum is covered Removable applience group PI (Plaque Index) Grade 0: No plaque Grade 1: Not visible thin coating of plaque which is only visible after using the probe Grade 2: Moderate accumulation of plaque, visible with the naked eye, but not filling interdental space 0 0 0

4 Grade 3: Abundance of plaque, filling interdental space GI (Gingival Index) Grade 0: No inflammation Grade 1: Mild inflammation, slight change in color, slight edema, no bleeding on probing Grade 2: Moderate inflammation, moderate glazing, redness, bleeding on probing Grade 3: Marked redness and edema, ulceration with tendency to spontaneous bleeding PSI (Periodontal Screening Index) Grade 0: No bleeding on probing, no pathologic pocket, no calculus Grade 1: Bleeding on probing up to 1 mm Grade 2: Calculus and no pathologic pocket Grade 3: Probing depth mm Grade 4: Probing depth > 5.5 mm TCI (Tongue Coating Index) Grade 0: No visible coating Grade 1: Less than a third of tongue dorsum is covered Grade 2: Less than two thirds of tongue dorsum is covered Grade 3: More than two thirds of tongue dorsum is covered The authors did not mention if the patients were instructed to clean of the tongue. This practice should justicated the decreased TCI by time in removable space mantener group Response: We mentioned if the patients were instructed to clean of the tongue and revisions were made regarding these considerations in MATERIALS AND METHODS/Page 5: line 36, patients were asked to brush their teeth and tongue supervised by their parents.

5 DISCUSSION/Page 8: lines 35-40, In this study patients were instructed to brush both teeth and tongue because previous studies indicated that increase in tongue coating and periodontal diseases were two major causes for halitosis (22,28). DISCUSSION/Page 10: lines 26-28, Tongue cleaning was in accordance with decreased halitosis scores in this study. Recent studies showed that tongue cleaning may positively affect the halitosis scores (29). 5. We wonder if conclusion could be shorter: The fixed and removable space maintainers did not affect oral health status and halitosis. The motivational factor of halitosis in oral health and its measurement are not the conclusion of the study Response: We removed the sentence Because halitosis is a sign of oral health status, we can say that, measuring halitosis is one of motivating factors for maintaining adequate oral hygiene during treatment with space maintainers according to your comments and and changes were showed in CONCLUSIONS/Page 10: lines 18-19, CONCLUSIONS The fixed and removable space maintainers did not affect oral health status and halitosis significantly. 6. We suggest the authors to include considerations about the limitations of the study. Response: We included considerations about the limitations of the study according to your suggestions and revisions were made in DISCUSSION/Page 10: lines 23-40,

6 A limitation of this study could be the lack of data on the organoleptic scores of the patients. Assessing halitosis by organoleptic method appears sensible, it has been suggested that halitosis should be diagnosed with two different methods, organoleptic and instrumental measurements (41). Because of the cross-infection risks of organoleptic measurement, only Halimeter used in this research.