Microbiota of the Tongue and Systemic Connections: The Examination of the Tongue as an Integrated Approach in Oral Medicine

Round 1

Reviewer 1 Report

The manuscript is structured as a review of the literature, and in some aspects it seems structured as a systematic one, although it's not to be considered as one of that kind.

An improvement should be made by the application of Prisma statement rules, and this could be a suggestion that could be made to authors.

English style is to be controlled and revised. 

Author Response

dear reviewer,

thank you for your advice on improving our manuscript.

We have tried to change and reorganize the manuscript from a systemic review to a  narrative  review by dividing the  manuscript  into parts.

We started  by discribing oral bacteria and the analysed the tongue and the correlations with systemic diseases.

We revised the English to make it as appropiate as possible

Reviewer 2 Report

This is a review areticle on tongue microbiota and systemic diseases, and how to examine the state of the tonghe. While the topic is interesting and well-written in some parts, I have concerns about the structure and quality of the manuscript. Several paragraphs are very short (only one sentence), giving the impression that this is not the final version of the manuscript. There is a  problem in how bacterial speices names are written. I think the manuscript needs a major revision before publication.

## specific comments 
### Structure of the manuscript:
It appears to be written written in a style of a systematic review, but I don't think the quality of the analysis is sufficient for a systematic review. I think the manuscript is better suited for a regular narrative review style and should be restructured as such. In other words, instead of having a Materials and Methods or Results sections, organize the entire manuscript in several subtopics and present them under subheadings. Below is an example of review areticles with such a style.
- Stevens EJ, Bates KA, King KC (2021) Host microbiota can facilitate pathogen infection. PLoS Pathog 17(5): e1009514. https://doi.org/10.1371/journal.ppat.1009514

### Names of bacterial species
- Bacterial species and genus names should be written italics.
- Write the complete name when the species first appears.
- After the first apperance, the genus name can be abbreviated.
Please refer to the rules in this article, for example, to revise how bacterial names are written throughout the manuscript. (https://www.enago.com/academy/write-scientific-names-in-a-research-paper-bacteria/)

Below are some examples I've noticed;
lane 95. Italycize bacterial names.
lane 103. same as above.
lane 141. Capitalize the first letter of the genus name. The gunus name may be abbreviated if it is not the first occurence (e.g. P. gingivalis).
lane 149. Because this is the first appearance of H. pylori, it's complete name should be spelled out.
line 209. Spell out the complete names of the bacterial specises if it is the first appearance.

### Other comments:
line 76. "high higher" - needs correction.
line 145. "109bacteria /ml10" - needs correction.
line 155. Why is this sentence written as a separate paragraph? what is meant by "This finding"?. It needs to be clarified or put into an appropriate paragraph.

All figures: Where did these pictures of tongues come from? I couldn't find any explanations in the text. Please clarify.

lines 176-193. Since there is almost no quantitative analyis on litarature in this article,  The Materials and Methods section and the first paragraph of the Result section seems unnecessary. Please change the style of the manuscript as a narrative review as pointed above.

line 257: This paragraph is too short. Please expand.

Author Response

dear reviewer,

Thank you  for your advice on improving our manoscript.

We have tried to change and reorganise the manuscript from a systemic review to a narrative review by dividing  the manuscript into parts.

As suggested we have deleted the part about materials anfd method and the results.

We organized the manuscript by initially describing the bacteria present in  the oral cavity  until we got to the specific examination of the tongue ans the systemic correlations.

we double-checked all the names of the   bacteria ,trying to quote them in full ,and we double checked that the names of the bacteria  were not "italianized".

The photos were provided by Dr.GIovanna Mosaico and Dr.Cinzia Casu .the two main authors with the consent of their patient.

We also tried to improve the English of the manuscript

Round 2

Reviewer 2 Report

The authors have responded well to my previous comments and the readability of the manuscript has significantly improved. The information presented in this manuscript will be useful for specific readers interested in this topic. However, there are still a few concerns that need to be addressed.

I noticed that the type of the manuscript has been changed to "Article." Although the description of how the literature search was performed has been improved (including the new prisma flowchart in fig.7), the description in the results section seems just a collection of description in the literature and fails to provide novelty as a systematic review. Therefore, I think this manuscript should be published as a review paper, not a research article. If this is a review paper, I think the lack of novelty will be a problem.

minor comment.
Lines 201-204. The meaning of "consultation only" was not clear to me. I would be great if this is clarified. 

Author Response

Please see the attachment

Author Response File: Author Response.docx