Review Reports

Round 1

Reviewer 1 Report

The Authors present the dental aspects peculiar to X-linked hypophosphatemia (XLH) and their treatment.

The manuscript is very well written and well illustrated and has the merit of making some still unfamiliar aspects of XLH better known.

I have only some very marginal remarks to make.

Today, there is a tendency to use the term 'mutation' less and less, while 'sequence variation' is preferred. This is mainly because it is often difficult to attribute a meaning to sequence variation, which is not always frankly pathogenic, whereas the term 'mutation' in its common meaning indicates pathogenic variation.

Page 2, line 74: in XLH the different expression in the two sexes is not as well established as the Authors report (see, for example, Ruppe MD. X-Linked Hypophosphatemia. 2012 Feb 9 [Updated 2017 Apr 13]. In: Adam MP, Everman DB, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK83985/).

Page 6, lines 146-147: when the Authors write "Short-term periodical dental check-ups are required for XLH patients" perhaps they would do well to also give a rough indication of the recommended frequency.

Page 7, line 207, the sentence “…after 3–6 months of medical treatment and should be continued for 6 months following implant surgery” perhaps it would be better “…after 3–6 months of medical treatment, which should be continued for 6 months following implant surgery”.

Author Response

Today, there is a tendency to use the term 'mutation' less and less, while 'sequence variation' is preferred. This is mainly because it is often difficult to attribute a meaning to sequence variation, which is not always frankly pathogenic, whereas the term 'mutation' in its common meaning indicates pathogenic variation.

(Response) Following the reviewer’s suggestion, we have changed the term “mutation” to “sequence variation”

Page 2, line 74: in XLH the different expression in the two sexes is not as well established as the Authors report (see, for example, Ruppe MD. X-Linked Hypophosphatemia. 2012 Feb 9 [Updated 2017 Apr 13]. In: Adam MP, Everman DB, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK83985/).

(Response) Thank you for your helpful suggestions. We have added the text “XLH the different expression in the two sexes is not as well established. The features of XLH are the same in males and females.” and recommended report before our description.

Page 6, lines 146-147: when the Authors write "Short-term periodical dental check-ups are required for XLH patients" perhaps they would do well to also give a rough indication of the recommended frequency.

(Response) Following the reviewer’s suggestion, we have clarified the indication of the recommended periodical dental check-ups from guideline of XLH.

Page 7, line 207, the sentence “…after 3–6 months of medical treatment and should be continued for 6 months following implant surgery” perhaps it would be better “…after 3–6 months of medical treatment, which should be continued for 6 months following implant surgery”.

(Response) Following the reviewer’s suggestion, we have changed the sentence.

Reviewer 2 Report

The article “Dental manifestations and oral management of X-linked hypo-2 phosphatemia” is very interesting and I have a comment with the intention of improving the manuscript.

 - A training guide or algorithm should be drawn up on the prevention of dental pathology and treatment of X-linked hypo- 2 phosphatemia patients, as well as the degree of recommendation for them. For example, on the topics of number of reviews per year by the dentist, type of topical application of fluoride, type of periodontal treatment, gingival prophylaxis treatment..., if these recommendations differ from patients without X-linked hypo- 2 phosphatemia.

References: Correct minor typos.

Figures: Consent for the publication of the images should be provided. Where does figure 4 come from?

Author Response

A training guide or algorithm should be drawn up on the prevention of dental pathology and treatment of X-linked hypophosphatemia patients, as well as the degree of recommendation for them. For example, on the topics of number of reviews per year by the dentist, type of topical application of fluoride, type of periodontal treatment, gingival prophylaxis treatment..., if these recommendations differ from patients without X-linked hypophosphatemia.

(Response) Thank you for your helpful suggestions. Unfortunately, there are no guidelines or systematic reviews to suggest a dental training guide or algorithm. It is hoped that dental practice guidelines for XLH will be established in collaboration with medical regions.

References: Correct minor typos.

(Response) Following the reviewer’s suggestion, we have rechecked of references.

Figures: Consent for the publication of the images should be provided. Where does figure 4 come from?

(Response) Following the reviewer’s suggestion, we have added “Informed Consent Statement”.

Reviewer 3 Report

Dear Authors, 

The manuscript is well written and It present a wide and interesting documentation.

I am sure that the subject matter is of interest to all clinicians dealing with paediatrics and oral health issues in young children.

The manuscript os ready to be considered for publication.

Best wishes

Author Response

The manuscript is well written and it present a wide and interesting documentation. I am sure that the subject matter is of interest to all clinicians dealing with paediatrics and oral health issues in young children. The manuscript is ready to be considered for publication.

(Response) Thank you. We really appreciate your positive comments.