Oral Health in Migrants: An Observational Study on the Oral Health Status of a Migrant Cohort Coming from Middle- and Low-Income Countries

Round 1

Reviewer 1 Report

The subject of the study is very interesting, but the data collection and choice of parameters should be modified and improved.

 

The aim of the study was to analyse the periodontal health status (CPI), the prevalence of dental caries (DMFT) and lesions of the oral mucosa in a migrant cohort resident in Italy, assessing the association between oral health status and educational level of the included patients.

 

Although the number of subjects included in the study is significant, several points should be modified to make the paper suitable for publication.

 

-      -In the materials and methods section, it is not explained extensively how the presence or experience of caries was assessed and how the educational level of the population was evaluated 

-      -the paediatric population should be distinguished from the adult population, especially when analyzing periodontal conditions

-      -Subjects older than 39 years of age should be enrolled to assess periodontal conditions 

-      -It would be opportune to compare the data collected with a control population, with dmft values for the paediatric population proposed by the WHO and/or with dmft/cpi data proposed by other epidemiological studies

-      -It would have been more appropriate to assess the periodontal status of patients using the criteria proposed by the new classification of periodontal disease

 

A more accurate and detailed data collection is necessary to investigate the objectives of this study. 

Author Response

Ferrara, 28^th May 2022

 

Dear editor:

Many thanks for the insightful comments and suggestions of the referees. We have made corresponding revisions according to their advice. Words in red are the changes

we have made in the text.

 

• In the materials and methods section, it is not explained extensively how the presence or experience of caries was assessed and how the educational level of the population was evaluated.

We explained better how the presence of caries was assessed and how the educational level was evaluated.

 

• the pediatric population should be distinguished from the adult population, especially when analyzing periodontal conditions.

We analyzed the DMFT /dmtf Index according to age in Table III, distinguishing this parameter based on the age range: 3-6 / 7-12 /13-20 / 21-37 years old. We added the analysis of CPI of children and adolescents in the “Results” section.

 

• Subjects older than 39 years of age should be enrolled to assess periodontal conditions.

This research was funded by the Italian Health Minister project titled “Dental caries prevention and screening among socially vulnerable subjects with difficult access to care”. Codice CUP E89C2000020001. According to this research grant, the selected population had to include all the patients visiting the dental department who were younger than 40 years.

We added the section “Limitation of the study” in which we specified that more accurate analysis should be performed also including patients older than 39 years of age.

 

• It would be opportune to compare the data collected with a control population, with dmft values for the pediatric population proposed by the WHO and/or with dmft/cpi data proposed by other epidemiological studies. We compared our data with a control population of other epidemiological studies, adding the analysis in the “Discussion” section.

 

 

• It would have been more appropriate to assess the periodontal status of patients using the criteria proposed by the new classification of periodontal disease.

We performed the periodontal health analysis by using the Community Periodontal Index (CPI) of Treatment Needs because many of the selected patients were children and adolescents and since many of them had a low level of cooperation, the CPI has been found to be the most effective and immediate diagnosis strategy.

 

 

 

 

Thank you for receiving our manuscript and considering it for publication.

We appreciate your time and look forward to your response.

 

 

Yours sincerely,

Dorina Lauritano

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments for author File: Comments.docx

Author Response

Ferrara, 28^th May 2022

 

Dear editor:

Many thanks for the insightful comments and suggestions of the referees. We have made corresponding revisions according to their advice. Words in red are the changes we have made in the text.

 

• Can you cite some statistics on the average DMFT/dmft and CPI of native Roman population or Italian population? This way we can see how the migrant cohort compare. Presumably, there is published data on this somewhere.

We cited some statistics on the average DMFT/dmft Index and CPI of the Italian population in the “Discussion” section.

• When you describe migrant patients does this also include refugees and asylum seekers or is it only economic migrants?

We included only economic migrants. We specified it in the “Materials and Methods” section.

• Could there be any selection bias since these individuals are turning up at a hospital dental center, presumably with some dental problems? Perhaps there are many migrants without dental problems who consequently have not sought any dental care?

We added the section “Limitation of the study” in which we specified this point.

• Since the overwhelming number of participants seems to be comprised of children (188 compared to 12 adults) it would perhaps make more sense to focus on the children since there really is a low number of adults and it might just skew the data.

This research was funded by the Italian Health Minister project titled “Dental caries prevention and screening among socially vulnerable subjects with difficult access to care” Code CUP E89C2000020001. According to this research grant, the selected population had to include all the patients visiting the dental department who were younger than 40 years.

In order to distinguish the data about children-adolescents and adults, we adjusted the results for age in Table III. Specific analysis of the prevalence of dental caries among migrant children in Italy will be our further objective.

• As you have lots of data on the dental status of these patients, I could propose a few further analyses that would be very interesting. For example, you could see whether there is any correlation between DMFT/dmft or CPI scores with macronutrient intake or sugar consumption per person in that country (https://ourworldindata.org/grapher/daily-per-capita-caloric-supply) or the income of the countries in GDP per capita or the education ranking of the countries (https://worldpopulationreview.com/country-rankings/education-rankings-by-country). Perhaps these could be supplementary analyses. This may also be of interest to other researchers, and I feel the data availability should be addressed. There would be a lot of benefits to making the data available I feel.

We added these considerations in the “Discussion” section.

• Presumably references 45 onwards which are just templates can be removed.

We removed references from 45 onwards.

Thank you for receiving our manuscript and considering it for publication.

We appreciate your time and look forward to your response.

Yours sincerely,

Prof.ssa Dorina Lauritano

Author Response File: Author Response.pdf