Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

In the manuscript entitled “Developing a multi-layer framework for integrating oral health into general health: A scoping review from oral healthcare workers’ perspective” the authors aimed to identify the main obstacles and drivers of integrating oral health into primary/general healthcare using oral healthcare professionals. The review synthesizes findings from 42 studies and organizes the evidence according to the Rainbow Model of integrated care, distinguishing macro-, meso-, and micro-level factors influencing integration. Overall, the manuscript is conceptually interesting and generally methodologically appropriate for a scoping review. However, some aspects of the methodology and interpretation of findings require clarifications to strengthen the scientific rigor of the work.

_ The manuscript aims to identify barriers, facilitators, advantages, and disadvantages of integrating oral health into general healthcare through oral healthcare professionals. However, the scope appears very broad, combining several analytical perspectives (barriers, facilitators, advantages, disadvantages, integration strategies, and policy implications). The authors should more clearly specify in the Introduction what is the primary outcome (e.g. mapping of integration models, identifying implementation determinants or developing a conceptual framework for integration).

_ The inclusion criteria restrict studies to those integrating oral health into general healthcare through oral healthcare professionals, excluding integration through other healthcare professionals. However, some included studies appear to involve interprofessional or medical-led models.

_ Appendix 1: The search strategies provided in Appendix 1 appear inconsistent across databases.

_ The results synthesize diverse study designs including qualitative studies, surveys, implementation projects, reviews, and commentaries. However, the Discussion occasionally interprets findings as if they represent strong empirical evidence rather than conceptual or exploratory insights. The authors should better emphasize that the present scoping review map available evidence rather than assess the strength of evidence, and therefore conclusions should be framed cautiously.

_ Plase, clarify in the text why Rainbow Model was chosen over alternative frameworks.

_ Most studies were conducted in the USA. The authos could discuss this limitation and its implications for generalizability.

Author Response

Dear Reviewer 1,

We sincerely thank you for handling our manuscript and for coordinating the review process. We also greatly appreciate the reviewers’ valuable and constructive feedback. All comments have been carefully addressed, and the corresponding revisions have been highlighted in yellow in the main text.

Reviewer 1

Comment 1: The manuscript aims to identify barriers, facilitators, advantages, and disadvantages of integrating oral health into general healthcare through oral healthcare professionals. However, the scope appears very broad, combining several analytical perspectives (barriers, facilitators, advantages, disadvantages, integration strategies, and policy implications). The authors should more clearly specify in the Introduction what is the primary outcome (e.g. mapping of integration models, identifying implementation determinants or developing a conceptual framework for integration).

Response: Thank you for this helpful comment, which has strengthened our manuscript. We have now included a clear outcome statement in the Introduction (Lines 130–132).

 

Comment 2: The inclusion criteria restrict studies to those integrating oral health into general healthcare through oral healthcare professionals, excluding integration through other healthcare professionals. However, some included studies appear to involve interprofessional or medical-led models.

Response: Thank you for this important observation. Our inclusion criteria focused on studies that integrate oral health into general healthcare through the involvement of oral healthcare professionals. However, we also included studies describing interprofessional or medical-led models where oral healthcare professionals were active members of the care team. These studies were considered relevant because they still reflect integration involving oral healthcare professionals within a collaborative framework.

 

Comment 3: Appendix 1: The search strategies provided in Appendix 1 appear inconsistent across databases.

Response: Thank you for your observation. Appendix 1 has been revised accordingly to ensure the search strategy is unique.

 

Comment 4: The results synthesize diverse study designs including qualitative studies, surveys, implementation projects, reviews, and commentaries. However, the Discussion occasionally interprets findings as if they represent strong empirical evidence rather than conceptual or exploratory insights. The authors should better emphasize that the present scoping review map available evidence rather than assess the strength of evidence, and therefore conclusions should be framed cautiously.

Response: Thank you for this important and insightful comment. We fully agree that, as a scoping review, the aim of this study is to map the breadth and nature of available evidence rather than to assess the quality or strength of that evidence.

In response, we have carefully revised the Discussion section to ensure that the interpretation of findings more appropriately reflects the exploratory and heterogeneous nature of the included studies, which comprise qualitative research, surveys, implementation studies, reviews, and commentaries.

 

Comment 5: Please, clarify in the text why Rainbow Model was chosen over alternative frameworks.

Response: Thank you for this insightful comment. The Rainbow Model was selected because it provides a comprehensive framework for understanding integrated care across multiple levels, including clinical, professional, organizational, and system integration. This multidimensional perspective aligns well with the aims of our study, which explores integration involving oral healthcare professionals within primary and general healthcare systems. Compared to alternative frameworks, the Rainbow Model offers a more holistic and structured approach to capturing the complexity of integration processes. We have now clarified this rationale in the manuscript. (Lines 140-145)

 

Comment 6: Most studies were conducted in the USA. The authors could discuss this limitation and its implications for generalizability.

Response: Thank you for this important comment. We acknowledge that most of the included studies were conducted in the United States, which may limit the generalizability of the findings to other settings. We have now added a statement in the final paragraph of the Discussion to highlight this limitation and its implications. (Line 133-136)

Reviewer 2 Report

Comments and Suggestions for Authors

Dear respected authors. By addressing the following points, the clarity and impact of your manuscript can be significantly improved, facilitating better understanding and engagement from readers.

1. The title is informative but requires refinement for clarity and grammatical accuracy. Specifically, the phrase ‘from oral healthcare workers' perspective’ should be corrected to ‘from oral healthcare workers’ perspectives.’

2. The highlight statement is not aligned with the study title or design. The phrase ‘using oral healthcare professionals’ is methodologically inappropriate and should be revised to reflect that the study synthesises their perspectives.
3. The aim statement requires clarification and grammatical refinement. The phrase ‘using oral healthcare professionals’ is ambiguous and should be replaced with ‘from the perspective of oral healthcare professionals.
4. The conclusion appears to be overclaimed for a scoping review. It presents the proposed framework as definitive and prescriptive, with implied readiness for implementation, which exceeds the methodological scope and evidentiary strength of a scoping review. The conclusion should be reworded to reflect the exploratory nature of a scoping review and to avoid presenting the framework as definitive or implementation-ready.

Author Response

Dear Editor-in-Chief,

We sincerely thank you for handling our manuscript and for coordinating the review process. We also greatly appreciate the reviewers’ valuable and constructive feedback. All comments have been carefully addressed, and the corresponding revisions have been highlighted in yellow in the main text.

Reviewer 2

Comment 1: The title is informative but requires refinement for clarity and grammatical accuracy. Specifically, the phrase ‘from oral healthcare workers' perspective’ should be corrected to ‘from oral healthcare workers’ perspectives.’

Response: Thank you for your observation. We made it correct.

Title- Developing a multi-layer framework for integrating oral health into general health; A scoping review from oral healthcare workers’ perspectives.

Comment 2: The highlight statement is not aligned with the study title or design. The phrase ‘using oral healthcare professionals’ is methodologically inappropriate and should be revised to reflect that the study synthesises their perspectives.

The aim statement requires clarification and grammatical refinement. The phrase ‘using oral healthcare professionals’ is ambiguous and should be replaced with ‘from the perspective of oral healthcare professionals.

Response: Thank you for this constructive comment. We have revised the aim statements to improve clarity and grammatical accuracy by replacing the phrase “using oral healthcare professionals” with “from the perspective of oral healthcare professionals”. The revised sentences are reflected in the Abstract (Lines 26–28) and Introduction (Lines 126–128).

Comment 3: The conclusion appears to be overclaimed for a scoping review. It presents the proposed framework as definitive and prescriptive, with implied readiness for implementation, which exceeds the methodological scope and evidentiary strength of a scoping review. The conclusion should be reworded to reflect the exploratory nature of a scoping review and to avoid presenting the framework as definitive or implementation ready.

Response: Thank you for this insightful comment. We have revised the Conclusion to better reflect the exploratory nature of a scoping review. The framework is now presented as a reference to inform future research and discussions, rather than a definitive or implementation-ready model.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

In their revised manuscript the authors addressed all the suggestions and clarified some few concerns.