AUCTORES
Chat with usReview Article | DOI: https://doi.org/10.31579/2694-0248/028
1 Orthopaedic Surgeon,Private Practitioner Mumbai, Maharashtra.
2 Department of Periodontology AND Oral Implantology M A Rangoonwala College of Dental Sciences and Research Centre, Pune.
3 Pedodontist and Preventive Dentist Private Practitioner.
4Assistant Professor dr Vasanat Rao Pawar Medical College, Nashik.
5Department of Periodontology and Oral Implantology M A Rangoonwala College of Dental Sciences and Research Centre, Pune.
*Corresponding Author: Sharayu Dhande, Department of Periodontology AND Oral Implantology M A Rangoonwala College of Dental Sciences and Research Centre, Pune.
Citation: Sagar Chaudhari, Sharayu Dhande, Sheetal Ajit Jangale, Ajit Govind Jangale (2022). Osteoporosis and Periodontitis: The Bi-Directional Link. J. Clinical Orthopedics and Trauma Care, 4(2); DOI:10.31579/2694-0248/028
Copyright: © 2022 Sharayu Dhande, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 10 January 2022 | Accepted: 20 January 2022 | Published: 17 February 2022
Keywords: osteoporosis; periodontitis; periodontal disease; tooth loss; fragility fractures; menopause; hormonal replacement therapy
Periodontitis is a multifactorial disease elicited by a complex of bacterial species, variety of risk factors, bacterial plaque, calculus that interact with host tissues causing the release of a broad array of inflammatory mediators, cytokines, chemokines some of which lead to destruction of the periodontal structures, leading to tooth mobility. Osteoporosis and Osteopenia are the conditions that represent the mineral content of the bone. In addition, aspects of bone composition and structure that may not be captured by bone mineral density measurements, such as bone size and geometry, and bone structure and material, contribute to increased bone fragility. Periodontitis as well as osteoporosis could also be risk factors for each other and have a impact that requires mutual concomitant management. An interventional approach is emerging with complex treatment options. Prevention and management of both of these diseases require interdisciplinary approaches and warrant future well-controlled longitudinal and interventional studies for evidence-based clinical guidelines.
Increasing life expectancy and popularity of dental implants, surgeons face a larger number of osteoporotic patients who require bone augmentation. [1] In addition, the combination of risk factors such as age, menopause, race, genetics, calcium intake, family history, medications and physical activity contribute to osteoporosis. [2-5]
Remodeling of bone in these units is important not only for maintaining bone mass, but also to repair microdamage, to prevent accumulation of too much old bone, and for mineral homeostasis. The activities of osteoblasts and osteoclasts are controlled by a variety of hormones and cytokines, as well as by mechanical loading. [6] Most importantly, sex hormones are very crucial for keeping bone mass in balance, and the lack of either estrogen or testosterone leads to decreased bone mass and increased risk for osteoporosis. The prevalence of osteoporotic fractures is increasing dramatically in the Western part of the world and is a major health problem in many countries. [7-8]
Periodontitis can be defined as the presence of gingival inflammation at sites where there has been a pathological detachment of collagen fibres from the cementum and the junctional epithelium has migrated apically. Inflammatory events associated with connective tissue attachment loss also lead to the resorption of coronal portions of tooth supporting alveolar bone. [9-10]
Osteoporosis, "too little bone in the bones," is a condition which mainly is seen in elderly women. The postmenopausal bone loss occurring in women can be an aggravating factor for osteoporosis. In cases of severe osteoporosis, the bone mass and structure of the skeleton are altered in such a way that the risk of fractures is very high. Since loss of alveolar bone is a notable feature of periodontal disease, severe osteoporosis could be suspected of being an aggravating factor in the case of periodontal disease. However, such a relationship is may easily be confounded by other factors such as gender, hormone intake, smoking, race, and age. [11-13]
The Global Burden of Disease Study conducted in 2016 reported that severe periodontal disease was the 11th most prevalent condition in the world. [14-15] Periodontitis and Osteoporosis both are diseases that are characterized by bone resorption. Osteoporosis involves systemic degenerative bone loss that leads to loss of skeletal cortico-cancellous microstructure and result in subsequent fracture, whereas periodontitis involves local inflammatory bone loss, following an infectious breach of the alveolar cortical bone, and it may result in tooth loss. Both diseases are defined by a preponderance of bone resorption, and their progression or severity is assessed systemically and/or locally. It is reasonable to argue that systematic skeletal change inevitably impacts the jaws and alveolar bone. [11-13]
The techniques currently used to assess osteoporosis include dual-photon absorptiometry (DPA), dual-energy absorptiometry (DXA), and quantitative computerized tomography (QCT). According to World Health Organization (WHO) osteoporosis is considered to be present when the bone mineral density (BMD) is 2.5 standard deviations below the young normal. Osteopenia is defined as bone density levels 1 standard deviation and 2.5 standard deviations below normal.[16] Preferred locations for diagnosing osteoporosis with BMD are the spine and hip and femur. On the other hand, methods for assessing periodontal conditions and oral bone loss include clinical probing depth (PD), attachment levels (CAL), tooth loss, radiographic measures of alveolar crest height (ACH), absolute bone density (DXA, DPA, QCT), and computer-assisted densitometry image analysis (CADIA). The diagnosis of osteoporosis is often made by using bone density measurements. They are often expressed in relative terms (T scores and Z-scores); the Z-score is the number of standard deviations from the age matched average value of healthy women. The T-score statistic is a simple transformation of the Z-score, using sample mean and sample standard deviation rather than the population mean and standard deviation. A low Z-score indicates the bone density is lower than it should be for a patient’s age and sex. Osteoporosis is defined as a BMD loss of 2.5 standard deviations or more below the established mean. [17]A precise, accurate measure for the degree of osteoporosis in the jaws by dual-photon absorptiometry. [18-24]
A robust association of osteoporosis and periodontal disease has been noted. Osteoporosis of the alveolar bone may lower the resistance of the periodontium to infectious challenge and may result in a local infection of the periodontium that first invades the cortical bone and results in a dimensional change in the alveolar ridge. [24-25] Another possible mechanism involves increased production inflammatory cytokines, in that osteoporosis patients have elevated systemic levels of pro-inflammatory cytokines IL-1, IL-6, and TNF-α. These cytokines account for osteoclastogenic bone resorption-inducing cytokines and are also involved in the tissue response to periodontal disease. [26] Both osteoporotic as well as osteopenic conditions predispose an individual to loss of attachment eventually resulting into loss of tooth. [27-30]
Genco and Grossi proposed a model, based on elevated levels of cytokines associated with post-menopausal oestrogen deficiency. [31] Deficiency in estrogen causes upregulation of macrophages and osteoblasts, which in turn produce inflammatory mediators such as interleukins, TNF-α and GM-CSF. This results in generalized collagenolysis and bone resorption. On the other hand, Yoshihara et al, found weak association between periodontal disease and BMD. The influence of estrogen upon bone remodelling like upregulation of osteoprotegrin is known to inhibits receptor activator of nuclear factor kappa B ligand (RANKL) results in breakdown of alveolar bone. Thus, it could be postulated that accelerated periodontal breakdown in osteoporotic patients is possibly a result of combination of elevated inflammatory responses and locally increased resorptive potential. [31]
In a study by Taguchi et al, a significant difference in BMD at the third lumbar vertebrae and posterior tooth loss was found. Similar results were found by Earnshaw et al in their study on early post-menopausal women with BMD and tooth loss. [32] Another retrospective study by Astrom et al demonstrated a positive correlation between tooth loss and incidence of hip fracture. [33]
RISK FACTORS : 11 Periodontitis is an inflammatory disease characterized by loss of connective tissue attachment and alveolar bone. Like osteoporosis, it is a silent disease, not causing symptoms until late in the disease process when mobile teeth, abscesses, and tooth loss may occur. While the etiologic agent in periodontitis is a pathogenic bacterial plaque in a susceptible patient, periodontitis and osteoporosis have several risk factors in common. They include an increased prevalence with increasing age, smoking, and influence of disease or medications that may interfere with healing. The rate of progression of periodontitis sharply increases immediately after menopause.
Osteoporosis :Sex, Age, Low bone mass, Early menopause, Thin, small-framed body, Race
Lack of calcium intake, Lack of exercise, Smoking, Alcohol and/or caffeine, Heredity, Certain medications (e.g., steroids), Propensity to fall.
Periodontitis :Bacterial plaque, calculus, Age, Smoking or medications that inhibit healing and/or immune response, History of previous bone loss. Osteoporosis has been proposed as a risk factor for periodontal disease. These established or potential risk factors also provide significant information regarding differential etiology and contributing factors that will assist clinicians in preventing or managing these two diseases simultaneously.
Common Risk factors : Cigarette smoking, Nutritional deficiency, Increased age, Corticosteroid use, Immune dysfunction
UNIVERSAL RECOMMENDATIONS FOR ALL PATIENTS : Numerous interventions like adequate intake of calcium and vitamin D, regular weight-bearing and muscle-strengthening exercise, cessation of tobacco and alcohol, treatment of other risk factors.
THE ROLE OF FRAX IN MAKING THE DIAGNOSIS OF OSTEOPOROSIS : FRAX is a World Health Organization-sponsored, country specific fracture risk assessment tool that combines BMD at the femoral neck (or total hip) with a group of well-validated and weighted clinical risk factors for fracture that are largely independent of BMD. Finally, for individuals who have an elevated fracture risk based on FRAX, the term osteoporosis can be used for diagnosis. [34] It is based upon epidemiological data from 60,000 women and men studied prospectively to correlate risk factors for fracture with fracture outcomes and then validated in independent cohorts including more than 230,000 patients. It is useful as a way of predicting the risk of hip fracture and major osteoporotic fractures, i.e., clinical spine, hip, proximal humerus, and distal forearm fractures, in previously untreated men and women aged 40–90 years. Its use in the USA allows the assessment of fracture risk in both genders and four ethnic groups and is recommended primarily for individuals with a BMD finding of osteopenia.
As a result, the reduced BMD, characterizing osteoporosis and further alteration of trabecular pattern may lead to a more rapid jawbones resorption caused by periodontal disease, resulting in the invasion of periodontal bacteria. Invading bacteria, in turn, may alter the normal homeostasis of bone tissue, increasing osteoclastic activity and reducing local and systemic bone density by both direct effects (release of toxins) and/or indirect mechanisms (release of inflammatory mediators; in particular, interleukin-1 and interleukin-6). [35-42]
POSSIBLE MECHANISMS OF THE BI-DIRECTIONAL LINK BETWEEN OSTEOPOROSIS AND PERIODONTAL DISEASE (PD) :
The relationship between osteoporosis and PD may be supported by the following mechanisms : [43]
Systemic to local bone resorptive disease : Other than the hormonal effect, the systemic to local bone resorptive disease is considered for describing the link between osteoporosis and periodontitis. Osteoporosis of the alveolar bone may lower the resistance of the periodontium to infectious challenge and may result in a local infection of the periodontium that first invades the cortical bone and results in a dimensional change in the alveolar ridge. On the other hand, it also causes altered bone density in maxilla as well as mandible and further leads to increased alveolar porosity, microarchitectural deterioration of trabeculae, reduced remodelling rate, reduction in volume of the residual ridge, and decrease in the cortical thickness following invasion by periodontal pathogens.
Few studies conducted on hormone replacement therapy (HRT) carried out in humans have reported improved mandibular bone density by reducing gingival bleeding and mobility of the teeth. Another hormone associated with homeostasis of bone is Parathyroid hormone (PTH), which increases resorption of bone to ensure sufficient levels of calcium within the blood. Thus, intermittent PTH application also aids to improve healing of the periodontium thereby promoting bone regeneration. Further PTH is also known to promote homeostasis of bone by regulating pro-resolving lipid mediators that are known to promote macrophage efferocytosis. [50, 51]
Together, these interactions suggest a possible link of interaction of hormones related to bone remodeling and inflammation may be a mechanism that links osteoporosis and periodontitis. [52-53]
Genetics is known to have a major role in periodontal disease pathogenesis. Certain twin studies and family based studies conducted by Krall & Dawson-Hughes, 1993; Gueguen et al. 1995 have indicated that 60–85% of the variance in bone mineral density (BMD) is genetically determined, while Arden et al. 1996; Garnero et al. 1996 assessed the effect of other risk factors for osteoporotic fractures, such as quantitative ultrasound properties of bone, femoral neck geometry and bone turnover markers range, have also been shown to have a strong heritable component. Cummings et al. 1995; Torgerson et al. 1996 conducted a study on family history of fracture and reported it to be a risk factor for fractures independently of BMD. Candidate gene association studies have shown several polymorphisms that are associated with BMD, bone loss or osteoporotic fractures.
Deng et al 2000 carried out a study on post-menopausal women to assess heritability of wrist fracture which was estimated about 25%, whereas compared to another study of twins carried out by Andrew et al 2005 suggested that the heritability of wrist fracture may be as much as 54%. Nevertheless, the heritability of wrist fracture in both these studies was shown to be largely independent of BMD, suggesting that predisposition would be affected due to genetic influences on other factors such as bone turnover, bone geometry or even perhaps the risk of trauma. [63-64]
STUDIES LINKING OSTEOPOROSIS AND PERIODONTAL DISEASE :
Kribbs et al 1990 was the first one to study the association between osteoporosis and periodontal disease in which he compared the mandibular bone mass of 85 osteoporotic women with 27 normal women. They concluded that the osteoporotic group showed less mandibular bone mass and density and a thinner cortex at the gonion compared the normal group. No significant differences in clinical periodontal measurements were found between osteoporotic and normal groups. [82]
Klemetti et al 1994 conducted a study on women aged 48-56 years. They reported greater number of tooth loss in post-menopausal women from low bone density category. The authors also concluded, women from the higher bone density category were known to retain their teeth inspite of deep periodontal pockets better than those underlying osteoporosis. [83]
A case-control study carried out by Von Wowern and colleagues 1994 comparing 12 female patients having osteoporotic fractures and 14 normal women, reported significantly greater clinical attachment loss in the osteoporotic women compared with normal women. The authors concluded that the osteoporotic women has less mandibular bone mineral content, as measured by dual photon absorptiometry, than the 14 women. The mandibular bone mineral density values found were less than 2 SD for mandibular bone content for young normal women in 92% of the osteoporotic group and in 64% of the control group that also suffered from mandibular osteopenia. The relationship between osteopenia and severity of periodontal disease also examined in a sample from the Third National Health and Nutrition Examination Survey (NHANES III) of 11,247 participants ranging from 20-90 years of age. Osteopenia of hip was significantly associated with severity of periodontal disease (mean attachment loss ≥ 1.5 mm) in females and males independently of the confounding effects of age, gender, smoking or intake of dietary calcium. This association was increased even further within the post-menopausal women. [25]
Further, Taguchi et al 1999 assessed relationship between bone mineral density and tooth loss in elderly women. Studies revealed reduced bone mass when susceptible to greater occlusal forces for a longer period of time has been suggested as one of the cause for increased molar tooth loss. [84] Furthermore, teeth with furcation involvement are at a significantly greater risk of premature tooth loss. Therefore, one may expect more multi-rooted teeth to be lost in patients with osteoporosis if there is a correlation between periodontal disease and osteoporosis. [84-86] Females with osteoporosis are three times more likely to experience loss of teeth. Techniques used to assess oral bone loss include radiographic measures of alveolar crestal height (ACH), residual ridge resorption (RRR), and probing measures to assess clinical attachment level (CAL) and measures of tooth loss. Oral bone density is measured through absolute bone density (DXA, DPA, QCT, RA) and CADIA (computer assisted densitometric image analysis) to assess approximate alteration in density over time. [87-90]
Taguchi et al 1999 found a significant difference in BMD at the third lumbar vertebrae and posterior tooth loss. [91]
Wactawski - Wende et al 2001 in their study conducted on 70 post-menopausal women, found a significant relationship between alveolar crest bone height as a measure of periodontitis and skeletal osteopenia (femur and lumbar spine) measured by DXA. This relationship was found as a result of combination of all associated risk factors like bacterial plaque, years of menopause and smoking. Interestingly, a confirmed co-relation was found between osteopenia at the hip and clinical attachment loss within the same group participants. [90]
Bollen et al 2004 studied the association between osteoporotic fracture and tooth loss. A positive co-relation was seen between residual alveolar ridge height and incidence of osteoporotic fractures. Although, reduced BMI remains the primary cause for fractures. [92]
Darcey et al 2013 carried out a study to assess whether there is a relationship between the osteoporotic status of patients and the number of their teeth. Total of 359 patients were scanned and their data was collected on osteoporotic status, smoking status, alcohol consumption, age and the use of hormone replacement therapy. Dental panoramic tomographs were advised for each patient and the total number of teeth present were assessed. The authors concluded a statistically significant relationship between molar loss and osteoporotic status of all the scanned individuals. [93]
D C Penoni et al 2018 conducted a Longitudinal Study and study included retrospective follow-up of 6-10 years to assess effects of Bone Fragility and Antiresorptive Drugs on Periodontal Disease and Tooth Loss. This study aimed to assess effect of systemic bone fragility over severe periodontal clinical attachment loss (CAL) and tooth loss over the years and to check the influence of anti-resorptive medications and periodontal maintenance. Elderly women were assessed for bone mineral density (BMD) and for fracture risk assessment (FRAX) in a cross-sectional analysis. The authors concluded that the use of bisphosphonates not only improved the bone condition but also the periodontal status. On the other hand, periodontal maintenance also minimized the negative impact of low BMD on periodontal tissues in the studied population. [94]
Hsin-Hua Chou 2021 studied association between Bone Mineral Density and Periodontal Disease in Middle-Aged Adult. A total of 7298 patients aged between 40 to 44 underwent oral screening. Data as collected on quantitative ultrasound for the measurement of bone mineral density (BMD) and Community Periodontal index was assessed for periodontal disease. The results showed prevalence of 39.8% of periodontal disease in adults with osteoporosis, followed by 33.3% of periodontal disease in osteopenic patients. The authors thus concluded, low bone mass was associated with the increased risk of periodontal disease. [95]
The authors thus recommend that postmenopausal women and also men over the age of 50 years should be undergo BMD testing on regular intervals in order to diagnose a marked risk of future fractures. However, there may be a disruption of the homeostasis involving bone remodelling, hormonal balance, as well as inflammation progression and resolution. Nevertheless, both of these diseases warrant for a interdisciplinary management.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner