For many talented clinicians who wish to share their cases applying the evidence base to support decision making or perhaps write a narrative review of the literature, there may be a knowledge gap in how they approach such a project, which may present a significant barrier. This article explains how a peer-reviewed paper, such as one submitted to Aesthetic Journal, is conceived, developed and written. It offers many useful tips and advice on how the paper should be presented in terms of language, style of writing and structure. It also explains the post-submission phase, including the peer-review process and the run-up to publication.
CPD/Clinical Relevance:
The publication of high-quality clinical cases and reviews has an essential educational role for other colleagues, yet writing to a sufficiently high standard to be published in a peer-reviewed journal may be a barrier.
Article
There is no doubt that many readers of Aesthetic Update are providing dental care to their patients of the highest standard, frequently documented by good quality clinical photography. However, these same clinicians may feel that barriers exist when considering writing up cases or indeed producing a narrative review of the literature of the required standard for such a peer-reviewed journal. There are several reasons for this. First, unless the potential author has completed a higher University degree such as a Master of Science (MSc) which, in its curriculum, included key skills such as scientific writing, critical appraisal and synthesis, it is unlikely that such an individual would possess the necessary academic skills to write a manuscript to the standard worthy of publication. Secondly, they may lack the confidence to submit their work to a journal where each paper is scrutinized by at least two subject experts. Thirdly, they may not be aware of the process from the genesis of the idea to publication. This article offers practical advice on writing in a scientific manner and constructing a paper that would be of a sufficiently high quality to be considered for publication in Aesthetic Update in particular.
What should be written about?
The first piece of general advice is to choose a topic which is of interest to the potential author or authors. This sounds obvious, but if a topic is chosen in which the author is not invested from an interest perspective, then they will get bored easily, find the process tedious and frustrating and ultimately abandon the project. The process takes many hours of reading, planning, writing, editing, referencing, and addressing reviewer comments, which is much easier and enjoyable with a subject about which the authors are passionate.
Secondly, the content of the intended paper should be ‘adding to the literature.’ In other words, the work should be original and fill a void in what has been published previously in the body of scientific work. An invaluable and essential exercise is first to perform a search of the literature using a university library or another commensurate resource. Commonly used databases include Medline via Ovid, Scopus, Web of Science and the Cochrane Library. This should inform and provide a good steer on previously published work and, therefore, expose any omissions in the literature.
Both these pieces of advice apply equally to a narrative review of the literature or a case study. The latter is obvious in that the clinician writes in detail about a clinical case that they have treated and discusses the significant points. A narrative review of the literature, otherwise known as a review article, is a synthesis (the pulling together) and critical appraisal (the value, relevance and dependability) of the available literature concerning the subject.
Most papers published in Aesthetic Update are review articles which are very different to systematic reviews which seek to methodically and reproducibly search the literature to locate all available evidence to answer a focused research question. The harvested information is presented as a critically appraised synthesis in a structured manner.
Structure of the manuscript
The big tip when writing a paper, be it a case report or review article, is that the author tells a story. There should be a beginning, a middle and an end. The work should be easy to read and presented logically, with the text being coherent and flowing from one sentence to the next and from one section to the next. This may be facilitated by planning out the article before beginning to write. This ‘brain dump’ allows the author to structure the manuscript and focus their writing. The first sentence of the paragraph sets out what is to follow in that paragraph. Ambiguity should be avoided so that it is clear to the reader what the author is saying.
The title should be carefully considered and accurately reflect the contents of the paper. There is no harm in conceiving the title once the article is written, or equally it could be written at the outset and used as a focus when developing the paper.
In the introduction, terms should be defined so the author can provide a sound foundation to avoid misunderstanding and ambiguity. The Glossary of Prosthodontic Terms is a tremendous resource for such an exercise.1 Acronyms should be explained at the first mention, for example, the European Society of Endodontology (ESE) has produced a position statement. Thereafter, the acronym may be used in favour of its long-hand version. The context of the paper should be explained to set the scene. This is done by briefly discussing previously published work in the field with reference to the literature and, therefore, why the work is necessary. The last sentence of the introduction should state the aim of the paper. In many cases, it is advisable to write the introduction last because the direction of the paper is then obvious, and the author can then set the scene in a more focused manner.
The main body of the work should be concerned with discussing and expanding the main points of the work. Sources of information should be synthesized, in other words, compared and contrasted, and not presented distinctly as ‘Bloggs said this’ and ‘Smith found that.’ Furthermore, and importantly, the papers that are being discussed require critical appraisal. Bespoke tools are available widely to assess quality of the paper, such as the appropriate Critical Appraisal Skills Programme (CASP) tool.2 Papers that, for example, present data with a small sample size, an incomparable population or a short period of follow-up, to mention three shortcomings, may limit the credibility of the conclusions being presented.
The last paragraph should summarize the main points of the paper and arrive at any definitive conclusions, so tying up the work. Furthermore, it is common, in a sentence or two, to include some recommendations to guide future work.
It is usual for the authors to supply an Abstract with their paper. This is sited on the title page of the manuscript and is essentially a summary of the paper in 100 to 150 words maximum. Aesthetic Update stipulates an upper limit of 150.
Scientific style of writing
Writing in scientific, formal language is a skill which takes a long time to master. A good tip for attempting to emulate such a style is to read good quality papers in reputable journals to gain an appreciation of the required standard. The other piece of advice is to practise and to keep practising, as mentioned elsewhere, many MSc programmes will have such skills incorporated into their curriculum. Once an individual has gone through the process of writing a thesis, then their ability to write is much improved and competent.
The convention for scientific writing is that it should be written in the passive voice, for example ‘the material was placed into the cavity.’ This makes the work sound professional and gives it more gravitas. It is acknowledged, however, that some journal styles do prefer the second person with the intention of ‘speaking’ to the reader, for example, ‘you should place the material into the cavity.’ The journal style should be followed when choosing the sense, but whatever is used, it should be consistent throughout the manuscript. This also goes for tense, be it present or past. A case study is usually written in the past tense, and a review article in the present.
Words have distinct meanings and should be used precisely and correctly. If there is any doubt, a dictionary should be consulted. For example, the data is not checked, but verified and indeed, the word ‘data’ is plural as in ‘the data were interrogated.’ Another example is that humans have mandibular teeth, not lowers and definitely not bottom…
It is important to qualify terms to afford their precise meaning, for example a composite material and a resin-based composite (used to restore teeth) are completely different beasts. Another example is the term ‘composite bonding’, which, although implied, is non-sensical. A more appropriate alternative would be a ‘resin-based composite material bonded to dental hard tissue’.
The use of lay terms should be avoided. For example, discussing the ‘x-ray’ with the patient is right and proper, yet between colleagues and, therefore in print, it is a ‘radiograph.’ That said, in case studies, inverted commas should be used to signify reported speech, for example, Mrs A, 35-year-old shopworker came into the clinic complaining of ‘a black front tooth.’
The use of apostrophes should be limited, namely ‘the tooth's surface’ versus ‘the surface of the tooth’, with the latter being preferred. Words should be written out long-hand, namely ‘advantages and disadvantages’ as opposed to ‘pros and cons.’ Abbreviations should be avoided, ‘patient’ instead of ‘pt.’ The last bit of writing advice is to use varied vocabulary to make the prose interesting and engaging for the reader, a thesaurus may be helpful in this regard.
Target audience
Many general dental practitioners (GDP) make the mistake of thinking that they are writing for their peers. However, the peer-reviewed literature is accessed by everyone: the academic community, all sections of the profession not to mention the keen layperson. This should be borne in mind when writing. The use of generic words, such as ‘clinician’ opposed to ‘GDP’ will, therefore, not alienate a great population of the readership of the journal.
Conventions
Italics
Italics should be used to demarcate non-English words such as ‘versus’ and similarly ‘et al,’ which should be used exactly as written here. Journal names also appear in italics, for example, ‘Aesthetic Update is published by the Mark Allen Group.’
Citing materials and products
The convention for citing commercial products is that on the first mention the name of the product, manufacturer, city of the company headquarters and country are written in parenthesis, for example, ‘a resin-modified glass ionomer (Vitrebond Plus, 3M, Seefeld, Germany).’ On subsequent references then, only the product name and manufacturer need to be stated: ‘a resin-modified glass ionomer (Vitrebond Plus, 3M)’ or perhaps ‘Vitrebond Plus (3M) was placed over the Biodentine (Septodont).’
Numerals
The normal convention is that the numbers one to nine should be written in long-hand, and numbers from 10 and above can be cited as numerals. Any measures of time, volume and length, should use a numeral along with the unit.
Clinical photographs
In a visual journal such as Aesthetic Update or its parent journal, Dental Update, high-quality photographs enhance papers greatly and are considered essential. That said, any photographs should be relevant and contribute something to the paper and not just included for the sake of it. They should be supplied in JPEG or similar format and as individual files for optimum reproduction. In most cases the anonymity of the patient should be protected with eyes blanked out. In some instances, however, this is not possible as it would detract from the point of the photograph. Clearly consent must be gained from the patient of any images with them fully aware of the consequences of publication especially in the latter example. It is the responsibility of the author to obtain this written consent and to retain such records.
It is permissible to use images gained from online sources provided that the author has gained permission from the owner to use them. The owner and the source of the image should be acknowledged in the legend of the figure. Some publishers will levy a charge for the use of some images and stipulate exactly how they should be acknowledged.
Referencing
All statements or points should be made with reference to the source in the literature. For example, ‘rubber dam usage is essential when moisture sensitive resin-based composite materials are being manipulated intra-orally, Mackenzie et al 2020.’3 A reference manager could be used to facilitate this somewhat tedious task. This is a piece of software that will handle and sort the references when they appear in the manuscript. Should the order of the paper be altered during the editing phase, then the software will automatically re-order the references, thus saving time, not to mention much frustration. There are several products on the market, such as EndNote, RefWorks and Mendeley, with each having its advantages and disadvantages. A useful feature of many of the aforementioned products is that the ‘cite as you write’ feature, which allows the author to make a statement and then immediately attach the appropriate reference, thus saving much time.
The style of referencing is prescribed by the journal, with many favouring Vancouver style. Examples of how the references should be set out are often given in the guidelines for authors. In Aesthetic Update, style requires that the reference is cited by means of superscripted numerals, after punctuation, in the text, and listed in order of mention in the reference section at the end of the manuscript. The use of a reference manager will automatically format the references in the required style, saving much time and frustration, which is another advantage of using such software.
It is a grave academic misdemeanour to plagiarize (copy) the work of another worker or even from any previously published work by the author themselves, which is termed self-plagiarism. Quoting another source is acceptable, provided the copied piece is captured in inverted commas with the source referenced. Alternatively, the source can be rephrased so that it is not exactly paraphrased. The source should still be referenced. With the advent of artificial intelligence (AI) tools, it is sometimes difficult to recognize whether such assisted technologies have been used in the production of a piece of work. Where AI has been used, then authors should disclose that this is the case and provide appropriate acknowledgement. Further details can be found in the ‘Guidelines for authors’.
Guidelines for authors
Each journal publishes its ‘Instructions for authors’ or ‘Guidelines for authors,’ which sets out what is expected of the manuscript by the editor and editorial team. It is highly recommended that the writer follows these instructions fastidiously during the writing of the paper, and then uses them as a checklist just prior to submission, as manuscripts can be rejected if they are not received in the prescribed format. Please see Appendix 1 for the newly updated ‘Guidelines for authors’ for Aesthetic Update.
Peer-review process
There are different types of dental ‘publications,’ such as social media posts, opinion pieces and the non-peer-reviewed dental press. There is no formal verification of the content of the output, and as a result, these are not held in the same high regard as the peer-reviewed literature.
Most reputable peer-reviewed journals (of which Aesthetic Update is one) will anonymize the submitted manuscript before sending it to two or more subject experts. These reviewers are also anonymized and make independent comments on the paper, such as its suitability for the journal, content, originality and appropriateness of the referencing. These reports are returned to the editor, who will then make a decision on the paper. Normally, there are four outcomes:
Accept as it is. In practice, this happens very rarely;
Accept subject to minor revisions;
Major revisions are recommended. If these are fully addressed, the paper may then be accepted for publication or it may be sent for further peer-review;
Reject.
In the experience of the author of the present paper, the comments received from peer-reviewers have enhanced all of their papers that have been subjected to this process. A good reviewer will act as a ‘critical friend’ with no agenda except to provide constructive feedback to the authors. Should the paper be rejected, or major revisions advised, then there should be no embarrassment or shame attached. Instead, it should be viewed as an opportunity to address the comments and enhance the paper. It is good practice to address each of the comments in turn so the editor can easily see that all have been considered by the author. If the author disagrees with any comment, they are within their rights to rebut it, but should support their argument with reference to the (peer-reviewed) literature. The editor of the journal will consider the response on its merits or otherwise.
Once the revised manuscript has been accepted, the paper is laid out as it would be for publication. The authors are then invited to check the proof for inaccuracies, such as typographical errors. Major alterations are rarely permitted at this stage. It is worth noting that many journals can have a significant lag time between acceptance and submission, which can lead to frustration and patience being required.
Conclusion
It is hoped that the practical advice offered in the present paper will guide especially inexperienced authors on their journey to publishing in the peer-reviewed literature. There is a great deal of satisfaction to be had in the scholarly discipline of writing and ultimately seeing the finished product in print. This not only directly informs the profession but indirectly benefits the care of the patient, the whole point of academia.
