Association Between DMFT Index and Sinonasal Anatomical Variations in Children: A Retrospective Cone-Beam Computed Tomography Study
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe manuscript is well written, the research is sound, only minor aspects to improve. Please see attached pdf
Comments for author File: 
Comments.pdf
Author Response
The answers are attached.
Author Response File: Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsDear Authors ,
please find the attached comments for your manuscript
Comments for author File: Comments.pdf
Author Response
The answers are attached.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsComments for Authors
- DMFT assessment methodology
The main methodological limitation of the study is that DMFT scores were assessed exclusively from reconstructed CBCT panoramic images without intraoral clinical examination. Radiological assessment alone has limited sensitivity for detecting early enamel lesions and may underestimate the true caries burden, particularly in younger children. Since this issue directly affects the interpretation of the reported association between NSD severity and DMFT scores, it should be more clearly emphasized throughout the manuscript.
- Important confounding variables were not included
Several major factors known to strongly influence DMFT scores, including oral hygiene habits, dietary patterns, socioeconomic status, and fluoride exposure, were not included in the analysis. Because of this, the observed relationship between NSD severity and DMFT should be interpreted cautiously, and the manuscript should avoid implying an independent effect of NSD on caries experience.
- Small severe NSD subgroup
The number of patients with severe NSD (Type III) was relatively small (n = 11). This substantially limits the robustness of comparisons across severity categories and should be more clearly acknowledged when interpreting the statistical significance of the observed trend between NSD severity and DMFT scores.
- Mechanistic interpretation should remain more cautious
Several parts of the Discussion move toward mechanistic interpretation by repeatedly linking NSD severity with mouth breathing, salivary alterations, and increased caries susceptibility, although these parameters were not directly evaluated in the present study. A clearer distinction between hypothetical biological explanations and findings directly supported by the collected data would strengthen the scientific balance of the manuscript.
- Observer reliability values should be reported
The manuscript states that inter- and intra-observer agreement analyses were performed; however, the obtained reliability values (e.g., Cohen’s kappa and/or ICC values) are not presented in the Results section. Since the study relies heavily on radiological interpretation and angular classification, these data should be explicitly reported.
- Conclusions should remain strictly associative
The Conclusions section is generally appropriately restrained; however, statements suggesting clinical implications of severe NSD should remain clearly framed as associative observations derived from a retrospective radiological study rather than clinically validated recommendations.
Author Response
The answers are attached.
Author Response File: Author Response.pdf
Round 2
Reviewer 3 Report
Comments and Suggestions for AuthorsThe revised manuscript has been substantially improved. The authors have appropriately addressed the major concerns regarding interpretation of the findings, study limitations, and the distinction between association and causation.
Only minor editorial revisions are recommended before publication, particularly a final check of language consistency and formatting throughout the manuscript.
