Hyperuricemia as a Systemic Risk Factor for Periodontal Disease: A Review of Clinical and Microbial Evidence

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The research addresses a novel and clinically relevant topic - investigating the relationship between gout and periodontal disease through inflammatory and microbial pathways.The study supports ongoing efforts to enhance periodontal hygiene measures in patients with gout with consistent oral hygiene practices to mitigate the risk of inflammation and infections. The abstract includes vital information and the conclusions drawn therein are supported by both the abstract and the text. Consistency is maintained with no discrepancies between the details presented in the abstract, text, tables, and figures. Any information provided in the abstract is appropriately represented in the main body of the text. The writing in the text is clear and easily understood. The manuscript presents a well-structured organization. The findings highlight the need for enhanced oral hygiene practices to reduce inflammation and microbial pathogens. The combination of a systematic review and a clinical case study enhances the paper. The evaluation of the PICOS framework for the systematic review together with specific clinical indicators for assessment ensures methodological rigor. Yet, the microbial analysis enriches the study .Bibliography is up to date.

My suggestion is to publish the paper in its present form

 

Author Response

Dear Reviewer,

We sincerely appreciate your time and effort in reviewing our manuscript and for your positive and encouraging feedback. We are grateful for your recognition of the clinical relevance of our study and its contribution to improving oral hygiene measures in patients with gout. Additionally, we truly appreciate your acknowledgment of the value added by the microbial analysis.

 

Kind regards

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

I can recommend this manuscript for publication after minor revision:

1. As a patient suffering from both gout and periodontitis, I am very interested in this study. But is gout really a potential trigger for periodontitis? I got periodontitis before the age of 30, but gout after the age of 30. This way, following the logic of the theme doesn't make sense. Therefore, I suggest changing to the correlation between high uric acid or renal inflammation and periodontitis, would it be better.
2. The literature format of this manuscript is extremely chaotic. Please unify it according to MDPI format.

Comments on the Quality of English Language

It's OK

Author Response

Dear Reviewer,

Thank you for your feedback and for sharing your personal perspective on the topic.

1. Is gout really a potential trigger for periodontitis?
   Your concern is valid, and we acknowledge that periodontitis and gout may not always follow a strict chronological order. Our study does not claim that gout directly triggers periodontitis but rather explores the association between these conditions through shared inflammatory and microbial pathways. The key link is systemic inflammation—patients with gout often have elevated uric acid levels and chronic inflammation, which can contribute to periodontal tissue breakdown. Several literature studies suggest that hyperuricemia and inflammation may increase susceptibility to periodontitis. However, this does not imply that gout must precede periodontitis in all cases, as multiple factors,including  lifestyle, oral hygene and other systemic conditions, play a role in disease progression.

1. Would it be better to focus on the correlation between high uric acid or renal inflammation and periodontitis instead?
   This is an excellent suggestion. Indeed, hyperuricemia are more directly measurable and may serve as stronger indicators of periodontal risk than gout itself. Our systematic review highlights studies that suggest elevated serum uric acid levels are linked to increased periodontal inflammation.

 

I have modified this aspect based on your recommendations. Please review the revised manuscript.

 

Kind regards,

 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript is fundamentally flawed in both design and execution, failing to meet the standards of a rigorous scientific study. Without a proper statistical framework, robust methodological justification, and a well-structured discussion, the study does not contribute meaningful scientific advancements. A complete overhaul of the study design, inclusion of statistically valid data, and a well-supported discussion are necessary before reconsideration for publication.

1. The clinical case study is anecdotal and lacks statistical power. A single case report cannot establish a meaningful association between gout and periodontal disease, making the study design fundamentally flawed.
2. The manuscript makes broad claims about the association between gout and periodontal disease without providing any statistical evidence to support these assertions. Without proper statistical testing, confidence intervals, or effect size reporting, the results cannot be considered scientifically valid.
3. The discussion section is weak and does not critically analyze the findings in the context of existing literature. There is no meaningful exploration of confounding variables, potential biases, or alternative explanations for the observed association.
4. The role of microbial pathways is mentioned but not substantiated with robust microbiological or immunological evidence, rendering the claims speculative rather than evidence-based.
5. The study fails to provide novel insights or practical implications for clinical practice. The claim that antimicrobial therapy is essential for managing periodontal disease in gout patients is not sufficiently supported by the data presented.
6. Without a comparative study, larger cohort analysis, or mechanistic validation, the conclusions remain premature and lack translational value.

Comments on the Quality of English Language

May be improved.

Author Response

Dear Reviewer,

Thank you for your evaluation of our manuscript. We greatly appreciate your detailed feedback, which provides valuable insights for improving the research. Below, we address your key concerns:

1. Study Design and Statistical Framework:
   We acknowledge your concerns regarding the study's design and the need for a more robust statistical framework. The primary goal of our manuscript was to explore the potential association between gout and periodontal disease through a systematic review of existing literature and a clinical case study. While the clinical case is not intended to establish causation, it serves to illustrate the potential clinical implications of this association. Future research will aim to include larger cohort analyses with statistical modeling to strengthen the evidence base.
2. Validity of the Clinical Case Study:
   We agree that a single case study does not provide generalizable statistical evidence. To improve the scientific rigor, we will clarify the limitations of the case study and emphasize that further studies with larger sample sizes are necessary to confirm our observations. Also, we have changed the type of study to a review study.
3. Statistical Evidence and Claims:
   While our manuscript primarily focuses on summarizing existing evidence, we will enhance the discussion by incorporating more detailed statistical findings from the reviewed studies,
4. Discussion and Critical Analysis:
   We appreciate your suggestion to strengthen the discussion section. We will refine our Additionally, we will expand on the microbial and immunological pathways by incorporating more detailed references to support our claims.
5. Clinical Relevance and Novel Insights:
   While our study contributes to the understanding of the relationship between hyperuricemia and periodontal disease, we acknowledge the need for stronger evidence regarding the role of antimicrobial therapy. We will refine our conclusions to ensure that they are well-supported by data and do not overstate the implications for clinical practice.
6. Future Directions:
   We agree that larger comparative studies, mechanistic research, and statistical validation are necessary to confirm our findings. We will highlight these as critical future research directions in the revised manuscript.

I have modified these aspects based on your recommendations. Please review the revised manuscript.

 

Kind regard,

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

Response is not fully address the queries.

Author Response

Dear Editor, 

Thank you for your recommendations. I have revised and attached the modified manuscript. 

Round 3

Reviewer 3 Report

Comments and Suggestions for Authors

Author has done significant improvement, now it can be accepted.