Reforming Dental Curricula: A Student-Centred Novel Approach Integrating Prosthodontic Care for Older Adults

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

The study addresses a highly relevant and contemporary topic. However, the review suffers from significant methodological, conceptual, and structural shortcomings that must be addressed before the manuscript can be considered for publication.

You define the manuscript as a scoping review, yet it is presented and structured more like a systematic review. Several critical components are lacking, including:

• Sufficient detail regarding inclusion/exclusion criteria,

• A quality appraisal of the included studies,

• Specific search strategies (e.g., exact search strings, timeframes),

• And notably, no risk of bias assessment is provided—an essential element even in a scoping review that synthesizes educational outcomes.

It is therefore imperative to include a table listing all 34 included studies, with accompanying metadata (e.g., study design, country, population, intervention, and outcomes), and to incorporate a flow diagram (e.g., PRISMA chart) within the main text to clarify the selection process.

Further concerns include:

• Considerable redundancy across sections, especially in the Discussion, where findings are reiterated rather than synthesized.

• In the Introduction, the discourse is often vague and unfocused, diluting the central argument.

• Sections such as “Create” and “Evaluate” are overly descriptive and lack critical depth.

• Tables A1–A7, while informative, appear disconnected from the narrative and should be integrated more systematically. Their placement solely in the appendix undermines their significance.

• The manuscript uses excessive or undefined jargon (e.g., “SOAP framework,” “serious games”), which reduces accessibility for readers outside of dental education. All abbreviations (e.g., SOAP) should be properly defined within the main text.

Moreover, the manuscript remains predominantly descriptive, with limited critical engagement regarding:

• The potential barriers to implementation of the proposed reforms (e.g., costs, faculty training needs, curricular overload), and

• The diversity of global dental education systems—many recommendations appear Eurocentric or assume resource-rich academic settings.

A major limitation of the manuscript is the lack of specificity in clinical or policy implications. What concrete steps should institutions take based on this review? What are the practical applications for curriculum developers?

These issues should be addressed comprehensively to enhance the clarity, rigor, and applicability of the study.

Regards.

Author Response

Dear Reviewer,

Thank you for your insightful and constructive critique of our manuscript. We appreciate your acknowledgment of the significance of the topic and your detailed recommendations for improving the methodological, structural, and conceptual rigor of the review. In response to your feedback, we have undertaken a comprehensive manuscript revision and are pleased to address your concerns systematically below.

1. Scoping Review vs. Systematic Review Structure:
   We recognize the initial structural ambiguity. The manuscript now follows scoping review standards in both framing and reporting. We adhered to the PRISMA-ScR 2020 extension for scoping review.
2. Inclusion/Exclusion Criteria:
   We have added a dedicated paragraph in the Materials and Methods section that details the inclusion and exclusion criteria used for study selection. These are clearly defined in terms of population, educational setting, study type, and relevance to geriatric dental education.
3. Search Strategy:
   The revised Methods section includes detailed database search strings and search platforms (PubMed, Scopus, Web of Science, Cochrane), without specifying a chronological timeframe. We aimed to classify studies according to Bloom's Taxonomy cognitive levels—from foundational knowledge recall (early studies) to innovative creation (latest studies). These details are fully reported to improve transparency and reproducibility (Section 2).
4. Risk of Bias and Quality Appraisal:

Protocols for bias and quality assessment were not used, as the review aimed to map and synthesize educational guidelines, not to evaluate individual studies. Unlike systematic reviews focusing on rigor, this scoping review prioritized conceptual relevance to capture diverse educational practices. (4.2 Limitations of the present Scoping Review)

1. PRISMA Flow Diagram and Metadata Table:
   We have added a PRISMA-ScR flow diagram (Figure 1) to illustrate the selection process, along with a comprehensive summary table of all 34 included studies (Tables 1-6) that details Implementation Type, Methods, and Sources. Additionally, Table 7 presents a cross-reference matrix aligning the ten strategic educational guidelines with Bloom's cognitive taxonomy levels and the studies that provide empirical support. Furthermore, new Figures 1-4 help the reader by illustrating the Methods used and Outcomes.
2. Redundancy in the Discussion:
   The Discussion section has been extensively revised to reduce redundancy and instead synthesize findings by theme. Each educational strategy is critically placed within Bloom's Taxonomy levels rather than repeating them.
3. Introduction Clarity:
   The Introduction has been revised to clarify the main argument, emphasizing the need for reforming geriatric prosthodontic education in light of global aging and educational gaps.
4. "Evaluate" and "Create" Sections:
   These sections have been expanded to include more critical analysis, with references directly linked to the reviewed studies to demonstrate synthesis at higher cognitive levels.
5. Tables A1–A7 Integration:
   These tables have been incorporated more systematically into the main narrative and placed in relevant sections. Cross-referencing has been enhanced to ensure each table aligns with its corresponding analytical section.
6. Clarification of Terms and Jargon:
   We have defined all specialized terms and abbreviations at their first mention in the main text. For example, "SOAP" is now clearly introduced as "Subjective, Objective, Assessment, Plan," and "serious games" are explained concerning simulation-based learning.
7. Barriers to Implementation:
   We now examine practical challenges in implementing educational reforms—such as faculty training, resource constraints, and institutional resistance—in the revised Discussion.
8. Global Applicability and 13. Clinical and Policy Implications:
   The present scoping review provides frameworks and strategic guidance for dental educators to navigate the complexities of geriatric dental care, excluding policy-related discussions covered elsewhere (although some references were included in section 4.2 Limitations of the present Scoping Review).

We are grateful for your critical insights, which have significantly enhanced the clarity, rigor, and utility of this work.

Reviewer 2 Report

Comments and Suggestions for Authors

1. The text does not clearly clarify what the Objectives are. They are stated, but in a vague manner. This makes the conclusions so generic that it is not clear whether they were achieved. 

2. The Method does not include the search algorithm used to extract the 365 studies. Nor does it explain how the filtering process was carried out down to 64 (or 34), as the Flowchart does not indicate. 

 3. It states that "A standardized data extraction form (of 64 selected studies) was developed to capture study characteristics, details of the methodology, population demographics, intervention parameters, and outcome measures." Where is that form? 

 4. The Results analyze the 34 articles, but it is not clear which ones they are, although it can be deduced that they are 24 to 57. At the end of the chapter, 10 educational guidelines are referenced, but it is not clear where they came from. 

 5. In the Discussion, the 10 educational guidelines are explained, but with little reference to the studies analyzed in the results. 

 6. The study is interesting, but it should be reviewed and these guidelines taken into account before publication.

Author Response

Dear Reviewer,

Thank you for your thoughtful feedback and recognition of the study's relevance. Your comments have significantly contributed to enhancing the clarity, structure, and transparency of the manuscript. Kindly find our detailed responses to each of your observations below.

1. Clarity of Objectives:
   We have revised the abstract, introduction, and methods sections to state and align the study objectives. The objectives are now explicitly listed in Section 1 and referenced in the conclusion to ensure consistency and clarity.
2. Search Algorithm and Study Filtering:
   The revised Methods section (Section 2) includes the complete search strategy, with Boolean operators and search strings, along with the databases searched and the date range provided by the PRISMA-ScR flowchart (Figure 1).
3. Standardized Data Extraction Form:
   We apologize for the omission. Data extraction is now described in Section 2, and the extracted data for all 34 studies are summarized in Tables 1-6, which outline Implementation Type, Methods, and Sources. Additionally, Table 7 is a cross-reference matrix that aligns the ten strategic educational guidelines with Bloom's cognitive taxonomy levels and the studies providing empirical support.
4. Identification of the 34 Analyzed Studies:
   The studies are now clearly identified by number and author in Tables 1-6 and cross-referenced in the Results and Discussion sections where applicable. The confusion between 92 and 34 has been clarified (92 studies were shortlisted and referenced in the paper, while 34 representative studies were selected to be organized using Bloom's Taxonomy).
5. Source of the Ten Educational Guidelines:
   We have now clearly traced the derivation of the ten guidelines from the thematic synthesis of the reviewed studies. Sections 3.1-3.6 offer a more precise outline of this connection, with keywords from each study written in italics. Therefore, each guideline was linked to specific studies and learning domains. We then developed ten pedagogically grounded, empirically supported, and adaptable educational guidelines through Bloom 's-aligned deductive mapping and inductive thematic analysis (shown in Section 3.7).
6. Connection Between Discussion and Results:
   Each of the ten guidelines is now contextually based on the evidence presented in the Results section. The results are thoroughly analyzed in Section 4.1, "Reforming Geriatric Prosthodontic Education Through Bloom's Taxonomy and Strategic Guidelines." The Discussion has been significantly revised to directly cite the studies that informed each educational strategy, ensuring a clear and logical connection between empirical findings and the proposed pedagogical recommendations.

We sincerely appreciate your constructive comments, which have enabled us to enhance the manuscript's coherence, methodological transparency, and scholarly value.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Excellent work — you have followed the reviewer’s recommendations. The manuscript is acceptable and constitutes a solid starting point for further assessments.

Regards.

Author Response

We wish to extend our sincere thanks to you and the reviewers for the thoughtful and constructive feedback provided on our manuscript. The comments have been invaluable in improving the clarity and scholarly rigour of our work. We have carefully revised the manuscript in accordance with all recommendations, and the amendments have been highlighted in red within the revised text for ease of review.

The principal revisions are as follows:

1. Competence versus Competency
   – Terminology has been revised consistently to employ competence, in line with (Hasan, A. Competence-based dental education. Br Dent J 236, 933 (2024). https://doi.org/10.1038/s41415-024-7576-4), to reflect the holistic conception of professional practice advocated in the manuscript. This strengthens the coherence of our argument and avoids any conflation of the two terms.
2. References
   – All inconsistencies in reference formatting have been corrected, including font, numbering, punctuation, and colour.
3. Abbreviations
   – Abbreviations such as DentCPD and Delhi-NCR were expanded at the first mention, and formatting has been standardised throughout.
4. Terminology Adjustments
   – The redundant pluralisation of OSCEs has been corrected to OSCE.
5. Figures
   – Figure 3 has been replaced with a higher-quality version to improve resolution and readability.
6. Spelling Conventions
   – The manuscript has been revised to conform consistently with UK spelling conventions.
7. Statistical Reporting
   – A clear statement has been added to indicate the statistical tests employed in the cited studies. In addition, the formatting of p-values has been standardised, and spacing and decimal inconsistencies have been corrected.
8. Critical Discussion of OSCE
   – The discussion has been expanded to acknowledge the limitations of OSCE as assessments at the “shows how” level of Miller’s pyramid. A contrast has been drawn with authentic assessment approaches (section 4.2)

These revisions have enhanced the manuscript's clarity and academic quality. We are most grateful for the editors' and reviewers’ careful engagement with our work and for the opportunity to refine and strengthen the paper.