The Neglected Role of Trichomonas tenax in Oral Diseases: A Systematic Review and Meta-analysis

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Trichomonas tenax (T. tenax) is a commensal flagellated protozoan found in periodontal microenvironment of the oral cavity, with a possible role in periodontal diseases. The purpose of the present systematic review and meta-analysis was to determine the worldwide prevalence of T. tenax infection and to show the neglected association of this parasitic infection with oral diseases.


To find literatures published until August 2020, five English databases (PubMed, Scopus, Science Direct, Web of Science and Google Scholar) were explored. Finally, 65 papers were qualified to be included in the current study.


Our results revealed a global pooled prevalence of 17% (95% CI 14–22%) for T. tenax infection. The highest prevalence was estimated at 56% (42–69%) in Chile, while the lowest prevalence was related to Kenya with 3% (1–6%). The age-based analysis found that the infection was most common in 46–55 mean age group with 15% (0–100%). The overall prevalence regarding culture method, molecular method and direct method was 21% (12–32%), 19% (8–35%) and 17% (12–23%), respectively. Moreover, the subgroup analysis showed the pooled prevalence in patient with candidiasis [22% (3–52%)], gingivitis [21% (9–36%)] and periodontitis [27% (10–48%)].


Our study specified a connection between T. tenax protozoa and periodontitis disease. However, more epidemiological studies as well as clinical trials are needed to precisely identify this relation.

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  • 01 March 2021

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This work was supported by the Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran under the contract no. IR.QUMS.Rec.1399.273.

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Correspondence to Milad Badri.

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Supplementary Information

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Supplementary Figure 1 Forest plot of odds ratios of Trichomonas tenax in case–control studies (PDF 327 KB)

Supplementary Figure 2 Forest plots for random-effects meta-analysis of Trichomonas tenax based on Mean Age (PDF 288 KB)

Supplementary Figure 3 Forest plot of odds ratios of T. tenax in male and female (PDF 290 KB)

Supplementary Figure 4 Forest plot of odds ratios of T. tenax in male and female (PDF 525 KB)

Supplementary Figure 5 Forest plots for random-effects meta-analysis of T. tenax among oral candidiasis patients (PDF 241 KB)

Supplementary Figure 6 Forest plots for random-effects meta-analysis of T. tenax in patients with Gingivitis (PDF 249 KB)

Supplementary Figure 7 Forest plots for random-effects meta-analysis of T. tenax in patients with Periodontitis (PDF 273 KB)

Supplementary Figure 8 Forest plots for random-effects meta-analysis of T. tenax based on smoking habit (PDF 266 KB)

Supplementary Figure 9 Forest plots for random-effects meta-analysis of T. tenax in patients with Immunodeficiency disorders (PDF 256 KB)

Supplementary Figure 10 Forest plots for random-effects meta-analysis of T. tenax among diabetic patients (PDF 213 KB)

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Eslahi, A.V., Olfatifar, M., Abdoli, A. et al. The Neglected Role of Trichomonas tenax in Oral Diseases: A Systematic Review and Meta-analysis. Acta Parasit. (2021).

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  • Prevalence
  • Trichomonas tenax
  • Worldwide
  • Oral health