For the 17 SRs we included but did not prioritize, we have added a brief explanation of our prioritization rationale to the Results section. Most often, these SRs were not prioritized because they were already included in a prioritized review of reviews (Ata-Ali 2020), or their PICOS were covered by a more recent or more relevant review. For transparency, we have also added a table to the Supplementary Materials to provide a list of the 17 non-prioritized SRs along with a specific rationale for why each was not discussed in the report.

For primary studies, we included all studies that addressed gaps in evidence from our included SRs (we did not prioritize any primary studies over others – all were discussed). We have added a sentence to the methods section to clarify this.

See response to comment #7 regarding how we prioritized SRs for discussion, and a brief overview of how we included all relevant studies that addressed gaps in SR evidence.

See responses to comments #18-27 regarding your additional suggested articles.

Thank you for asking me to comment on this Evidence Synthesis document. The literature in is this still-emerging field is not easily summarized, due to the lack of long-term studies and heterogeneity of study design. Nevertheless, the intriguing potential of this body of work, specifically improved health outcomes for patients with certain chronic diseases associated with the provision of preventive dental/periodontal care, makes this an important area of interprofessional research.

Here are my comments:

We have added Nasseh 2017 to the report.

We previously discussed the limitations of Jeffcoat 2014 (ref #57) – including the fact that their control group consisted of patients who have had 1, 2, or 3 periodontal treatment visits (not 0 visits), which is one of the major criticisms raised by Sheiham 2015.

Additionally, in our “Limitations” section, we previously commented that a major limitation of our included non-RCTs is the “high risk that confounders could have influenced results.”

Specific Comments:

Key Findings/ Executive Summary: My first impression of the key findings box was that the authors appeared equivocal/ambiguous in their conclusions. The use of words/phrases such as “unclear”, “may improve” repeatedly, connotes a lack of confidence about the findings or their conclusions. Could it be that the results are unclear because of the rapid approach to synthesizing the evidence? My fear is that this uncertainty will leave a similar impression on the policy makers who are the intended audience for this report. The review of the evidence should help the readers lean one way or the other, otherwise it does not add much value to the body of knowledge or the decision-making process.

Introduction/ Background: I found it sufficient. The purpose, scope, key questions, and eligibility criteria were clearly laid out.

Some minor suggestions:

Ln 53, Page 2: Please add a reference about who made this hypothesis.

Figure 2: KQ4 should include the treatment arm, for those who received treatment for their dental problems

Thank you.

Regarding p. 2, line 53- it is difficult to track down who first made this hypothesis, so instead we’ve rephrased the sentence to say periodontal disease “may contribute to worsening of diseases whose etiology or severity are in part driven by chronic inflammation” and provided 2 references that discuss this possible relationship.

Regarding figure 2- we have revised the figure so that KQ4 encompasses the treatment arm as well.

Methods:

Ln 9, Page 7: Spell out acronyms in full at first mention. e.g CDSR

Ultimately, we chose to only search for primary studies that addressed gaps in SR evidence due to 2 factors- 1) there were several moderate and high-quality SRs that addressed several of our PICOs of interest and 2) the review was a rapid product and was to be completed in a short time frame. However, in response to this comment, we have added a search for primary studies on CVD/diabetes & chronic disease indicators from 2019 – 2020. This will ensure we’ve captured studies published since the end date of our most recent, relevant SRs’ searches.

To your second point about meta-analysis- we added a statement in the “synthesis of data” section to explain that we did not conduct a meta-analysis specifically among those with COPD or cerebrovascular disease because of variability in study designs, outcome measurements, and timing of outcome timing.

Thank you for pointing this out- the study labeled “R” was an include and was erroneously added in the excluded table. E9 (outdated or ineligible review) has been added to the table.

We have also added our full inclusion/exclusion criteria as an additional appendix in the Supplementary Materials for full transparency.