Development of an Oral Health Index and Its Association with Oral Health-Related Quality of Life and Cardiovascular Risks: A Cross-Sectional Study
, Larissa Knysak Ranthum 1, Luiz Felipe Manosso Guzzoni 2, Marcela Claudino 3, Eduardo Bauml Campagnoli 3 and Marcelo Carlos Bortoluzzi 1,*
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe Authors proposed and validate an Oral Health Index, which integrates multiple clinically assessed oral health variables. Apart from the low novelty of these findings, there are several important issues in the manuscript that should be corrected, and the paper extensively rewritten before it can be submitted for publication.
Introduction
1.If there is a well-documented link between oral health and cardiovascular disease, why did the authors decide to study this topic again?
- What indicators for assessing the condition of the oral cavity do the authors mention?
Materials and Methods
1.Why did the authors not take into account such important oral health factors as dental caries, the presence of fillings or the state of oral hygiene when planning the index?
- Where were the patients examined - in which clinic (city, country)?
- The authors mentioned traumatic ulcers, oral lichen planus, oral cancer, and osteoradionecrosis: have such cases occurred?
Discussion
In the discussion, the authors did not compare their results with those of other authors. This should be added to the article.
Conclusion
„This study proposed and validated a novel Oral Health Index (OHI), designed to
integrate multiple clinical parameters into a single standardized measure of oral health” -Authors should not assess oral health and write about a comprehensive assessment index without taking into account dental caries, restorations, and oral hygiene status.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsDear Authors,
Please see attached file for detailed comments.
Comments for author File: Comments.pdf
Author Response
Please see the attachment
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsLine 122: Please provide previous research on (EMRRH).
Line 127: Please provide previous research on (OHIP-14).
Line 134: Does "postgraduate examiners" refer to dentists? If they are licensed examiners, please indicate their occupation.
Tooth loss: Why were third molars included? Third molars are deteriorating and many people have none.
Additionally, it appears that prevalent dental caries was not included. Please discuss the reasons for its exclusion.
Considering the OHI weighting, tooth loss is a very important factor in oral health among the various oral health items. It represents the final stage of all oral health. Was the OHI weighting not considered?
Figure 1. Please place the legends at the bottom of the figure.
Line 295: Although not essential, it would be better to display the demographic factors of the study participants in a table for readability.
Discussion
I acknowledge the usefulness of the OHI, as discussed by researchers. However, this study is cross-sectional and examines associations, so caution is needed regarding exaggerated language. Please correct any exaggerated language.
The OHI has limitations in its use as an indicator of overall health.
Author Response
Please see the attachment
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsAuthors respondentów to all questions.
Reviewer 2 Report
Comments and Suggestions for AuthorsDear Authors,
You have responded thoughtfully and in good faith to the first-round critique. The revised manuscript shows clear conceptual tightening, more cautious language, and improved statistical transparency. Importantly, you no longer frame the Oral Health Index (OHI) as a “validated” instrument in a strict psychometric sense, but rather as a population-standardized composite index with external, association-based support. This reframing substantially improves methodological accuracy.
Most major concerns raised previously have now been adequately addressed.
The manuscript has improved substantially and now presents a methodologically coherent, transparently limited, and appropriately framed exploratory analysis.
