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J Dent Res. 2020 Feb 5:22034520901738. doi: 10.1177/0022034520901738. [Epub ahead of print]

Entamoeba gingivalis Causes Oral Inflammation and Tissue Destruction.

Bao X1Wiehe R1Dommisch H1Schaefer AS1.


A metagenomics analysis showed a strongly increased frequency of the protozoan Entamoeba gingivalis in inflamed periodontal pockets, where it contributed the second-most abundant rRNA after human rRNA. This observation and the close biological relationship to Entamoeba histolytica, which causes inflammation and tissue destruction in the colon of predisposed individuals, raised our concern about its putative role in the pathogenesis of periodontitis. Histochemical staining of gingival epithelium inflamed from generalized severe chronic periodontitis visualized the presence of E. gingivalis in conjunction with abundant neutrophils. We showed that on disruption of the epithelial barrier, E. gingivalis invaded gingival tissue, where it moved and fed on host cells. We validated the frequency of E. gingivalis in 158 patients with periodontitis and healthy controls by polymerase chain reaction and microscopy. In the cases, we detected the parasite in 77% of inflamed periodontal sites and 22% of healthy sites; 15% of healthy oral cavities were colonized by E. gingivalis.

In primary gingival epithelial cells, we demonstrated by quantitative real-time polymerase chain reaction that infection with E. gingivalis but not with the oral bacterial pathogen Porphyromonas gingivalis  strongly upregulated the inflammatory cytokine IL8 (1,900 fold, P = 2 × 10-4) and the epithelial barrier gene MUC21 (8-fold, P = 7 × 10-4). In gingival fibroblasts, we showed upregulation of the collagenase MMP13 (11-fold, P = 3 × 10-4).  Direct contact of E. gingivalis to gingival epithelial cells inhibited cell proliferation. We indicated the strong virulence potential of E. gingivalis and showed that the mechanisms of tissue invasion and destruction are similar to the colonic protozoan parasite E. histolytica. In conjunction with abundant colonization of inflamed periodontal sites and the known resistance of Entamoeba species to neutrophils, antimicrobial peptides, and various antibiotics, our results raise the awareness of this protozoan as a potential and, to date, underrated microbial driver of destructive forms of periodontitis.


Quintessence Int. 2020;51(3):212-218. doi: 10.3290/j.qi.a43948.

Presence of Trichomonas tenax and Entamoeba gingivalis in peri-implantitis lesions.

Arpağ OFKaya ÖM.



The aim was to investigate the presence of Entamoeba gingivalis and Trichomonas tenax in peri-implantitis lesions.


A total of 141 individuals were included in this study, of which 40 had clinically healthy implants (group H); the remaining were associated with peri-implantitis (group P). Gingival crevicular fluid was collected using absorbent paper, followed by a dental plaque sample from the peri-implant sulcus/pocket using a titanium curette. The samples were transferred into an Eppendorf tube. Each specimen was divided into two parts. One part was examined under a light microscope at a 10 × and 40 × magnification to detect parasites. The other part was spread on a microscope slide, stained with Giemsa stain, and examined under a microscope at 100 × magnification. Pearson chi-square test was used in the statistical analysis of data, with a significance level of P < .05.


Although there was no presence of parasite around the healthy implants, two parasites were detected in peri-implantitis lesions. Out of 101 lesions, 31 (30.7%) showed E gingivalis, and 34 (33.6%) presented with T tenax. There was a statistically significant difference between the presence of E gingivalis and demographic data including gender, education status, frequency of dental visits, and brushing frequency. Presence of T tenax in lesions was correlated with frequency of dental visits (P < .05). It was observed that E gingivalis and T tenax were mostly detected in the mandible (P = .004 and .014, respectively) in comparison with the maxilla.


This study showed that peri-implantitis lesions were involved with E gingivalis and T tenax, in contrast to the healthy areas.


Giemsa staining; dental implants; direct microscopy; microbiology; parasite; peri-implantitis

J Oral Microbiol. 2019 Nov 25;12(1):1693222. doi: 10.1080/20002297.2019.1693222. eCollection 2020.

Protozoans in subgingival biofilm: clinical and bacterial associated factors and impact of scaling and root planing treatment.

Dubar M1,2Zaffino ML2Remen T3Thilly N3Cunat L2Machouart MC2,4Bisson C2,5.


Objective: In patients with periodontitis, identification of protozoans and evaluation of some bacteria and clinical parameters associated and assessment of scaling and root planing (SRP) impact on their detection. Methods: Before and after SRP, subgingival microbiota was collected in two pathological and one healthy site from 30 periodontitis patients. One healthy site from 30 control patients was also sampled. The usual clinical periodontal parameters were recorded; microbial detection was determined by PCR hybridization system for bacteria and qPCR for protozoans. Results: In periodontitis group, Trichomonas tenax and two subtypes of Entamoeba gingivalis (ST1 and a variant ST2) were detected in respectively 33.3%, 70% and 18.3% of pathological samples, and in 6.7%, 10% and 3.3% healthy samples. In control group, ST1 alone was found in 3.3% of individuals. ST1 was associated with Gingival Index, Clinical Attachment Level (p ≤ 0.03) and with the total bacterial count (p = 0.02). T. tenax alone was associated with P. gingivalis, T. denticola and E. nodatum (p ≤ 0,02). After therapy, only T. tenax detection decreased significantly (p = 0.004) and no association between the protozoan elimination and improvement of pathological sites was found. Conclusions: Protozoans were associated with some clinical parameters and/or periodontopathogens in patients with periodontitis.

Free PMC Article

Ann Parasitol. 2019;65(3):257-265. doi: 10.17420/ap6503.208.

The in vitro activity of selected mouthrinses on the reference strains of Trichomonas tenax and Entamoebagingivalis

Moroz J1Kurnatowska AJ2Kurnatowski P2.


Protozoa, such as Trichomonas tenax, Entamoeba gingivalis and Leishmania braziliensis, may be present in the mouth but their role in the pathophysiology of oral diseases is not clear yet. The use of various types of mouthrinses plays an important role in maintaining proper oral hygiene and in removing some of the microbial components from the oral cavity. The purpose of this study was to investigate the effects of selected mouthrinses on the reference strains of Trichomonas tenax and Entamoeba gingivalis which can be a part of the oral cavity microbiota. Two standard strains Trichomonas tenax (ATCC 30207) and Entamoebagingivalis (ATCC 30927) were used and metronidazole as a drug used in the treatment of infections caused by protozoa as well as fourteen agents used as mouthwashes were tested, with two pure compounds acting as mouthrinse ingredients, i.e. 20% benzocaine and 0.2% chlorhexidine, as well as 12 commercially-available formulas: Azulan, Colgate Plax Complete Care Sensitive, Corsodyl 0.2%, Curasept ADS 205, Dentosept, Dentosept A, Eludril Classic, Listerine Total Care, Octenidol, Oral-B Pro-Expert Clinic Line, Sylveco and Tinctura salviae. The protozoonicidal activity of the preparations was evaluated on the basis of the ratio of dead to living ratios after incubation in an incubator (37°C) for 1, 10 and 30 min. Protozoa were counted in the Bürker chamber in each case up to 100 cells in an optical microscope (over 400×). The criterion for the death of protozoa was the lack of movement and changes in the shape and characteristics of cell disintegration. The curves of activity were obtained after experiments conducted for 5–7 different solutions of each preparation. On the basis of the curves, the solution killing 50% of the population (CL50) was calculated. All mouthrinses tested in this work in their undiluted form acted lethally on both protozoa. Benzocaine, used as a local anesthetic, has etiotropic properties which can be useful for supporting antiprotozoal treatment. Chlorhexidine confirmed its high efficiency in the eradication of potentially pathogenic protozoa. The use of mouthrinses is an important complement for other procedures intended to maintain correct oral hygiene.

Front Cell Infect Microbiol. 2018 Oct 29;8:379. doi: 10.3389/fcimb.2018.00379. eCollection 2018.

Reassessing the Role of Entamoeba gingivalis in Periodontitis.

Bonner M1Fresno M2,3Gironès N2,3Guillén N4,5Santi-Rocca J6.


The protozoan Entamoeba gingivalis resides in the oral cavity and is frequently observed in the periodontal pockets of humans and pets. This species of Entamoeba is closely related to the human pathogen Entamoeba histolytica, the agent of amoebiasis. Although E. gingivalis is highly enriched in people with periodontitis (a disease in which inflammation and bone loss correlate with changes in the microbial flora), the potential role of this protozoan in oral infectious diseases is not known. Periodontitis affects half the adult population in the world, eventually leads to edentulism, and has been linked to other pathologies, like diabetes and cardiovascular diseases. As aging is a risk factor for the disorder, it is considered an inevitable physiological process, even though it can be prevented and cured. However, the impact of periodontitis on the patient’s health and quality of life, as well as its economic burden, are underestimated. Commonly accepted models explain the progression from health to gingivitis and then periodontitis by a gradual change in the identity and proportion of bacterial microorganisms in the gingival crevices. Though not pathognomonic, inflammation is always present in periodontitis. The recruitment of leukocytes to inflamed gums and their passage to the periodontal pocket lumen are speculated to fuel both tissue destruction and the development of the flora. The individual contribution to the disease of each bacterial species is difficult to establish and the eventual role of protozoa in the fate of this disease has been ignored. Following recent scientific findings, we discuss the relevance of these data and propose that the status of E. gingivalis be reconsidered as a potential pathogen contributing to periodontitis.


Entamoeba gingivalis; gingivitis; infectious disease; inflammation; parasitic infection; periodontitis

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Sci Rep. 2017 Jun 16;7(1):3703. doi: 10.1038/s41598-017-03804-8.

Dysbiosis in chronic periodontitis: Key microbial players and interactions with the human host.

Deng ZL1Szafrański SP2Jarek M3Bhuju S3Wagner-Döbler I4.


Periodontitis is an extremely prevalent disease worldwide and is driven by complex dysbiotic microbiota. Here we analyzed the transcriptional activity of the periodontal pocket microbiota from all domains of life as well as the human host in health and chronic periodontitis. Bacteria showed strong enrichment of 18 KEGG functional modules in chronic periodontitis, including bacterial chemotaxis, flagellar assembly, type III secretion system, type III CRISPR-Cas system, and two component system proteins. Upregulation of these functions was driven by the red-complex pathogens and candidate pathogens, e.g. Filifactor alocis, Prevotella intermedia, Fretibacterium fastidiosum and Selenomonas sputigena. Nine virulence factors were strongly up-regulated, among them the arginine deiminase arcA from Porphyromonas gingivalis and Mycoplasma arginini. Viruses and archaea accounted for about 0.1% and 0.22% of total putative mRNA reads, respectively, and a protozoan, Entamoeba gingivalis, was highly enriched in periodontitis. Fourteen human transcripts were enriched in periodontitis, including a gene for a ferric iron binding protein, indicating competition with the microbiota for iron, and genes associated with cancer, namely nucleolar phosphoprotein B23, ankyrin-repeat domain 30B-like protein and beta-enolase. The data provide evidence on the level of gene expression in vivo for the potentially severe impact of the dysbiotic microbiota on human health.

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Ann Parasitol. 2016 Oct 1;62(3):233-237. doi: 10.17420/ap6203.57.

Comparative assessment of selected intraoral microorganisms – potential factors for peri-surgical management complications

Zawadzki PE1Starościak B2Perkowski K3Baltaza W4,5Padzik M4Pionkowski K4Chomicz L4.



In this research, a comparative analysis of results of investigations involving different human populations, in terms of a relation between the oral cavity health and the species composition of mouth microbiota is reported. The purpose of this analysis was to identify and assess microorganisms that could cause health complications in patients with neoplasm requiring dental problem-related surgical management. The patients with the oral cancer surgically treated and those without neoplasm were assessed for their oral health: status of teeth, gingiva, periodontium, and occurrence of inflammatory processes. From each patient, microorganisms isolated of periodontium, dental plaque, and dental pocket swabs were identified in wet and stained microscopic preparations; standard microbiology in vitro techniques were also applied to determine the fungal and bacterial strains. The comparative analysis of results of direct microscopic examinations and in vitro cultures assessment indicated significant differences in prevalences of fungi, parasitic oral protozoans and bacteriae in particular patient’s groups. Yeast-like fungi belonging to Candida genus, mostly of C. albicans group, were identified in 93.75% patients with the oral cancer, while in 25% of individuals assessed without neoplasm. E. gingivalis amoebae were only found in 12.5% patients with the serious disease; no trichomonads were detected in all patients analyzed. Among bacteria species, potentially pathogenic Enterobacteriaceae were found in the patients with oral cancer. The pronounced shift in the microbiota species composition in the patients who needed prolonged treatment due to oral cavity cancer, compared to other generally healthy persons has been showed in this analysis.

J Dent (Shiraz). 2016 Sep;17(3):171-6.

The Effect of Nonsurgical Periodontal Therapy on Trichomonas Tenax and Entamoeba Gingivalis in Patients with Chronic Periodontitis.

Rashidi Maybodi F1Haerian Ardakani A1Fattahi Bafghi A2Haerian Ardakani A3Zafarbakhsh A4.




Trichomonas tenax and Entamoeba gingivalis are commensal protozoa which inhabit the human oral cavity. These parasites are found in patients with poor oral hygiene and might be a reason for progressive periodontal diseases.


The aim of this study was to evaluate the effect of nonsurgical periodontal treatment on the frequency of these protozoa in saliva and plaque samples.


In this clinical trial, samples of saliva and dental plaque were collected from 46 patients with moderate to severe chronic periodontitis before and after periodontal therapy. The samples were assessed for the frequency of parasites.


The frequency of Entamoeba gingivalis was reduced in saliva (p= 0.007) and plaque (p= 0.027) three weeks after the treatment. Likewise, the frequency of Trichomonas tenax reduced in saliva (p= 0.030); however, the decrease was not significant in plaque (p= 0.913). Trichomonas tenax frequency in dental plaque directly related to the severity of periodontitis (r= 0.565, p≤ 0.000). In contrast, the number of Entamoeba gingivalis in both saliva (r= -0.405, p≤ 0.005) and plaque (r= -0.304, p= 0.040) was inversely related with the severity of the periodontal disease.


Nonsurgical periodontal treatment could reduce the number of Trichomonas Tenax and Entamoeba gingivalis in the oral environment of patients with chronic periodontitis.


Entamoeba Gingivalis; Parasite; Periodontitis; Trichomonas Tenax

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J Biol Regul Homeost Agents. 2016 Apr-Jun;30(2 Suppl 1):143-7.

The ecological catastrophe of oral diseases: a possible link between periodontitis and protozoa.

Lauritano D1Lo Muzio L2Gaudio RM3Lo Russo L2Mucchi D4Nardi GM5Scapoli L6.



Periodontal disease (PD) is one of the prevalent diseases in the adult population. The ethiology of PD has never been completely understood, however, loss of balance between the host immune system and the microbial virulence of PD pathogens may be considered the trigger of PD. In fact, the immune system, activated by microbiological agents, attacks the host and not the biofilm bacteria, causing the destruction of periodontal tissue, alveolar bone and loss of teeth. Parasites may play an important role in the pathology of PD. The first studied and the most common parasite in the oral cavity is Entamoeba gingivalis. A possible link between E. gingivalis and PD has never been demonstrated completely, however E. gingivalis is infrequently found in people without PD. In addition, there is evidence that E. gingivalis could favour the onset and progression of PD. In conclusion, we can assert that E. gingivalis and PD may be correlated. This relationship can open new therapeutical approaches for treating PD, particularly in cases refractory to therapy.

Ann Parasitol. 2016;62(1):71-6. doi: 10.17420/ap6201.35.

Evaluation of selected oral cavity microbiota–risk factors of management complications in patients with masticatory system disorders.

Zawadzki PJ1Perkowski K2Starościak B3Dybicz M4Baltaza W5,6Pionkowski K5Chomicz L5.



The retrospective analysis of data on oral cavity clinical status in relation to microbiota species composition is presented. The research regards patients of different age, with and without congenital malformation, pretreatment assessed for occurrence of pathological changes in the masticatory system. Samples of the swabs collected from each patient (from dental plaque, periodontium and dental pockets) were used for identification of oral protozoans in wet slides and stained preparations; additionally, transmission electron microscope examination was performed. The material was used for in vitro cultures to identify bacteria strains. Clinically, intensity of tissue deteriorations was higher in patients with a congenital disease. Alive Trichomonas tenax and Entamoeba gingivalis, species with confirmed pathogenic impact on oral cavity and neighboring structures, were detected with higher prevalence in older patients. Enterococci, Staphylococcus aureus, various Enterobacteriaceae were more frequently detected in patients with somatic and mental retardations; in mouths of those patients, Klebsiella pneumonia and Pseudomonas aeruginosa opportunistic strains occurred. Masticatory system abnormalities favor colonization of oral cavity by exogenous species and dissemination of infections, especially dangerous for patients with congenital diseases. Oral microbiota assessment and preventive measures may be helpful to avoid subsequent peri-surgery complications.

Turkiye Parazitol Derg. 2016 Mar;40(1):17-21. doi: 10.5152/tpd.2016.4351.

Investigation of Entamoeba gingivalis and Trichomonas tenax in Periodontitis or Gingivitis Patients in Kayseri.

Yazar S1Çetinkaya ÜHamamcı BAlkan AŞişman YEsen ÇKolay M.




The aim of this study was to determine the prevalence of Entamoebagingivalis and Trichomonas tenax in periodontitis and gingivitis patients.


The study consisted of 107 periodontitis patients and 68 gingivitis patients. Bacterial plaque samples were collected with a curette from the deepest pocket in each quadrant and placed into separate tubes containing sterile 0.9% saline solution. Samples were examined at a magnification of ×400 by light microscopy. Cultivation for T. tenax was performed using the same samples, and the cultures were examined after 48 hours.


  1. gingivalis was present in the samples from 38 periodontitis patients, whereas T. tenax was present in samples from only 3 periodontitis patients. Both E. gingivalis and T. tenax were found together in the samples from 2 periodontitis patients. In total, 22 and 2 gingivitis patients were found to be infected with E. gingivalis and with T. tenax, respectively. Only 1 gingivitis patient was found to be infected with both E. gingivalis and T. tenax.


In our study, oral protozoa were found in a high percentage in periodontitis and gingivitis patients. We believe that the prevalence of E. gingivalis and T. tenax should be determined via new studies and, in particular, the protection principles should be complied with.

Parasite. 2014;21:30. doi: 10.1051/parasite/2014029. Epub 2014 Jul 2.

Detection of the amoeba Entamoeba gingivalis in periodontal pockets.

Bonner M1Amard V2Bar-Pinatel C2Charpentier F2Chatard JM2Desmuyck Y2Ihler S2Rochet JP2Roux de La Tribouille V2Saladin L2Verdy M2Gironès N3Fresno M3Santi-Rocca J3.



Periodontitis is a public health issue, being one of the most prevalent diseases worldwide. However, the aetiology of the disease is still unclear: genetics of patients cannot explain the dispersed or isolated localisation of gingival pockets, while bacteria-based models are insufficient to distinguish gingivitis and periodontitis. The possible role of parasites in the establishment of periodontitis has been poorly studied until now. The aim of this project was to study a potential link between colonisation of gingival crevices by the amoeba Entamoeba gingivalis and periodontitis. In eight different dental clinics in France, samples were taken in periodontal pockets (72) or healthy sites (33), and submitted to microscopic observation and molecular identification by PCR with a new set of primers designed to specifically detect E. gingivalis. This blind sample analysis showed the strong sensitivity of PCR compared with clinical diagnosis (58/72 = 81%), and microscopy (51/65 = 78%). The results of this work show that the parasites detected by microscopy mainly – if not exclusively – belong to the species E. gingivalis and that the presence of the parasite is correlated with periodontitis.

© M. Bonner et al., published by EDP Sciences, 2014.

Free PMC Article

Parasitol Res. 2011 Sep;109(3):857-64. doi: 10.1007/s00436-011-2312-9. Epub 2011 Mar 12.

Use of PCR to detect Entamoeba gingivalis in diseased gingival pockets and demonstrate its absence in healthy gingival sites.

Trim RD1Skinner MAFarone MBDubois JDNewsome AL.



Investigators using light microscopy have identified the protozoan parasite Entamoeba gingivalis from diseased gingival pockets for nearly 100 years. The objective of the present investigation was to develop a molecular biology approach for determining the presence of E. gingivalis in both diseased gingival pockets and healthy gingival sites. For this, a previously developed conventional polymerase chain reaction (PCR) was evaluated and a real-time polymerase chain reaction assay was developed. Paper points were inserted into the base of the sulcus of both diseased gingival pockets and healthy gingival sites. DNA was extracted using the QIAamp DNA mini kit, and subsequently analyzed using conventional and real-time PCR analysis. A previously described primer set specific for the small subunit ribosomal RNA gene (SSU rDNA) of E. gingivalis was used for the conventional PCR. For the real-time PCR, a primer set was designed to amplify a 135-bp fragment inside the SSU rDNA of E. gingivalis. A conventional PCR assay detected E. gingivalis in 27% of diseased gingival pockets. The real-time PCR using a different primer set detected protozoa in 69% of diseased pocket sites. Thus, the latter technique proved more sensitive for detection of E. gingivalis. No E. gingivalis were detected in any of the healthy gingival pocket sites using either type of PCR assay. Results support a concept that the presence of E. gingivalis is associated only with diseased gingival pocket sites. The newly described methodology may also serve to provide a novel eukaryotic cell marker of disease status in gingival pockets.

Turkiye Parazitol Derg. 2010;34(2):91-4.

[The investigation of Entamoeba gingivalis and Trichomonas tenax in a group of patients with periodontal disease].

Abualqomsaan M1Töz SOYolasiğmaz ATurgay N.



The oral cavity is suitable for invasion of many microorganisms. Entamoeba gingivalis (E.gingivalis) and Trichomonas tenax (T.tenax) settle in the oral cavity of patients with poor oral hygiene and gingival disease. In the present study, two slide specimens were prepared from the cole region of the teeth of 46 persons for investigation of the parasites. One of the slide specimens was dried in the air while the other one put into fixative and they were stained with trichrome and Giemsa stains. The two staining methods were used for 36 samples and only Giemsa, for 10 samples. E. gingivalis was positive in 7 (19.44%) out of 36 samples stained by the trichrome stain while T. tenax was positive in one (2.17%) out of 46 samples stained by Giemsa stain. Parasitic infections were found to be positive in seven (21.2%) specimen from 33 patients with periodontal disease and in one (7.69%) specimen from 13 healthy controls. Dental policlinics are generally far from parasitology laboratories and microscopical wet mount examination can not be performed. Therefore dentists can send the specimens and have the parasites diagnosed with Giemsa and trichrome staining methods as an alternative to wet mount examination.


Indian J Dent Res. 2010 Jan-Mar;21(1):89-91. doi: 10.4103/0970-9290.62821.

Prevalence of oral Entamoeba gingivalis and Trichomonas tenax in patients with periodontal disease and healthy population in Shiraz, southern Iran.

Ghabanchi J1Zibaei MAfkar MDSarbazie AH.




It was shown that two parasites of Entamoeba gingivalis (E. gingivalis) and Trichomonas tenax (T. tenax) may be responsible for oral parasitic infection. This study was designed to evaluate the prevalence of these parasites in oral cavity of patients with periodontal disease and in healthy population in Shiraz, Southern Iran.


A total of 50 patients with periodontal disease (case group) and 50 subjects with healthy gingiva (control group) entered in the present study. A questionnaire recorded general health, smoking habits, and any history of antibiotic consumption during the last six months for each patient. In the case group, saliva was collected by sterile swab and the gingival crevicular fluid by the paper point. The plaque and calculi were collected by sterile curette and scaler. In the control group, saliva and gingival crevicular fluid were collected and sent to laboratory for further studies.


In the case group, nine patients were infected, six with E. gingivalis and three with T. tenax. Seven patients had mobility of the teeth, one patient was smoker and five had previous history of antibiotic consumption. In the control group, only one subject was infected with E. gingivalis without any history of smoking and antibiotic consumption.


Parasitic infections are relatively common in patients with periodontal disease. It seems that follow-up of instructions are essential in control of parasitic infection in Southern Iran.

Turkiye Parazitol Derg. 2010;34(4):155-9. doi: 10.5152/tpd.2010.03.

[Investigation of the relationship between oral and dental health and presence of Entamoeba gingivalis and Trichomonas tenax].

Özçelık S1Gedık TGedık RMalatyali E.




Entamoeba gingivalis and Trichomonas tenax can cause gingivitis and scale. In this study, the prevalence of E. gingivalis and T. tenax were investigated among patients who were admitted to the Cumhuriyet University, Faculty of Dentistry.


Two scraping samples were taken from 220 patients (ages varying from 12 to 75 years) and a questionnaire including fifteen parameters was applied to all patients. The samples were diluted in Physiological Saline and examined immediately by Tech Lab Entamoeba Kit and Robinson Medium.


Oral protozoa were detected in 58 (26.4%) of 220 scraping samples. In 48 (21.8%) of the positive 58 specimens, E. gingivalis was detected alone whereas T. tenax was present in only two (1%) specimens. In 8 (3.6%) specimens, E. gingivalis and T. tenax were identified together. Gender, age groups, dental caries and the number, shape disorders, systemic diseases, tooth pain, joint problems and wisdom teeth were not found to be significant with the presence of oral protozoa. However, gum problems, presence of tartar, smoking habits, brushing habits and control habits were found to be statistically significantly related with the presence of oral protozoa.


In the present study, E. gingivalis and T. tenax were found to be common. These parasites, with additional parameters, may lead to gingivitis and scale.

Braz Dent J. 2000;11(1):49-57.

Risk indicators for periodontal diseases in Guatemalan adolescents.

Pomes CE1Bretz WAde Leon AAguirre RMilian EChaves ES.



A random sample of sixty-two 11-15-year-old adolescents from 17 different locations in Guatemala were selected for this study. Pocket depth, Plaque Index, and bleeding upon probing were recorded from 6 randomly selected sites in each subject (a total of 372 sites). Subgingival plaque samples were subsequently collected from these sites and processed by several assays. For cost reasons, in each pair of sites different assays were performed as follows: sites #1, #2–BANA test for T. denticola, P. gingivalis, B. forsythus and screening of plaque samples with polyclonal antibodies (ELISA system) for A. actinomycetemcomitans; sites #3, #4–detection of yeasts by SAB agar; sites #5, #6–detection of Entamoeba gingivalis by the Heidenhain iron hematoxylin modified technique. A total of 66% of the children had at least one site that bled upon probing, 42% exhibited at least one site with pocket depth > 3 mm, and 79% exhibited a high Plaque Index, with the percent of sites affected being 30%, 12% and 41%, respectively. In sites #1, #2 (N = 124), the BANA test assay and A. actinomycetemcomitans tested positive in 77% and 47% of the children accounting for 59% and 31% of the sites, respectively. In sites #3, #4 (N = 124), yeasts were detected in 43% of the children and 29% of the sites. In sites #5, #6 (N = 124), Entamoeba gingivalis was detected in 21% of the children and in 11% of the sites. The risk for severe gingival inflammation and/or increased probing depth was 1.5 and 5.2 times higher if a positive BANA test or A. actinomycetem comitans test was found in a particular site. No associations could be found for yeasts and Entamoeba gingivalis.

Bratisl Lek Listy. 1998 Nov;99(11):567-72.

[Morphology and diagnosis of the oral protozoans Trichomonas tenax and Entamoeba gingivalis using the Giemsa-Romanovsky stain].

Vráblic J1Vodrázka JTomová SStaník RCatár G.



In the microscopic diagnosis of Trichomonas tenax and Entamoeba gingivalis is the technically and time not demanding native preparation of a culture, in which both protozoans can be detected according to their typical motility, determining. In the permanent preparation of the culture stained according to Giemsa-Romanovsky, which has also documentary character, are all of the characteristic cell organelles stainable, enabling so their detection without their typical motility. Staining according to Giemsa-Romanovsky is technically simple and not time consuming, not very laborious, low cost and the coloration is permanent, that means optimal for the diagnostic of oral protozoans in permanent preparations. (Fig. 5, Ref. 4.).

J Egypt Soc Parasitol. 1994 Dec;24(3):649-55.

Frequency of Entamoeba gingivalis among periodontal and patients under chemotherapy.

el Azzouni MZ1el Badry AM.



This study was carried out to investigate the frequency of E. gingivalis in the gingival crevices of patients with periodontitis compared to normal subjects. Flagyl therapy was tried in cases with periodontitis. Also the frequency of this amoeba was investigated in patients receiving chemotherapy to be compared to normal subjects. The results revealed that higher frequency was observed in patients with periodontitis and flagyl therapy reduced this frequency. Cases under chemotherapy showed higher frequency than the normal control. Histopathological sections from the gingiva of periodontitis patients did not show any amoeba invading the tissue.

J Egypt Soc Parasitol. 1992 Apr;22(1):101-5.

The prevalence of Entamoeba gingivalis and Trichomonas tenax in periodontal disease.

el Hayawan IA1Bayoumy MM.

Author information


Two hundred patients (100 males and 100 females) having either marginal periodontitis or gingivitis were examined for detection of E. gingivalis and T. tenax. E. gingivalis was more prevalent among patients with periodontitis particularly females, while T. tenax was not discovered entirely in both patients and control groups.

Rev Odontostomatol (Paris). 1990 Jan-Feb;19(1):37-45.

[Importance of Trichomonas tenax  and Entamoeba gingivalis protozoa in the human oral cavity].

Feki AMolet B.


Trichomonas tenax and Entamoeba gingivalis are protozoa found in the human oral cavity. Morphological and ultrastructural characteristics of those parasites were reviewed and then studied with the scanning electron microscope in this paper. Based on previous epidemiological studies, the relationship between periodontal disease and those protozoa was analysed. Evaluation of the pathogenicity of Trichomonas tenax and Entamoeba gingivalis was also part of the discussion of this study.

Int J Parasitol. 1989 Nov;19(7):803-8.

Clinical survey of Entamoeba gingivalis by multiple sampling in patients with advanced periodontal disease.

Linke HAGannon JTObin JN.


A clinical survey of Entamoeba gingivalis was conducted in patients with advanced periodontal disease.  A total of 100 specimens were taken from 10 patients (four females and six males) who were each sampled at 10 disto-facial random sites. The oral hygiene of the persons scored from good to fair to poor and very poor. The age of the test persons ranged from 20 to 68 years. All persons examined harbored E. gingivalis: the minimum prevalence was four sites positive out of 10 and the maximum prevalence was 10 sites positive out of 10 for the protozoan. It is recommended that for reliable testing of the presence of E. gingivalis at least five-10 different sites should be examined within the periodontium of each patient. Data reported earlier in the literature on the incidence of E. gingivalis–obtained after a single sampling per individual–are believed to be on average too low and, therefore, should be interpreted with caution.

Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Stomatol. 1989 Oct-Dec;36(4):279-85.

[Periodontal diseases with Entamoeba gingivalis].

Sefer M1Boanchis AIChaouki SHGanescu VConstantin P.



At the beginning of our century Entamoeba gingivalis was considered to be a pathogenic bacteria, capable to induce parodontal lesions.  Later on it was also found in healthy persons, and the germ was less interesting from the medical view-point.  In the present study the authors report their findings concerning E. gingivalis in 135 patients with various stomatological affections including: dental caries, parodontopathies, pulpitis, gangrene, ulcero-necrotic stomatitis etc. The study was started following the discovery of the amoeba in the gingival exsudate of a male aged 19 years with chronic superficial marginal parodontopathy, who, after a treatment with metronidazol, was cured. Entamoeba gingivalis belongs to the Rhizopoda class, together with E. dysenteriae, and E. coli, but, in contrast with these strains it does not have resistance forms (cysts). Oral amoeba were evidenced in 18 out of 78 patients with parodontal lesions (23.07%), in the gingival exsudate, the purulent secretion from parodontal pouches, in the dental tartar, the alveolar fluid following extraction etc. In 117 students from the Faculty of Stomatology, and in 57 patients with various other stomatological affections these germs were not found in any of the abovementioned products. Microscopic examination of fresh preparations, and of Giemsa-stained smears was the main method for the detection of the amoeba. The etiopathogenic role of E. gingivalis is re-examined in discussions regarding certain parodontopathies.

Entamoeba gingivalis in sputum smears.

Dao AH.


Entamoeba gingivalis is a common parasite of the human buccal cavity whose rare appearance in Papanicolaou-stained sputum smears may be missed. Two such cases are described, including the morphologic features of this ameba. The trophozoites were seen to phagocytize leukocytes as well as red blood cells, in distinction to E. histiolytica, which phagocytizes only red blood cells and also can cause pulmonary abscesses. The concomitant finding of Actinomyces sp. organisms in one patient reinforces the possible symbiotic relationship between the two organisms, as has been suggested for their appearance in other extraoral sites, such as the female genital tract.

Am J Clin Pathol. 1983 Sep;80(3):380-3.

Frequency of Entamoeba gingivalis in human gingival scrapings.

Dao AHRobinson DPWong SW.


A survey was made of gingival scrapings stained by the Papanicolaou method to assess the occurrence of Entamoeba gingivalis, a nonpathogenic-oral amoeba. Positive findings were recorded in 59% of 113 dental patients, and 32% of 96 healthy controls. These figures showed no significant changes during the last 20 years when compared with data published in 1960 and 1963. The existence of E. gingivalis and its rare appearance in the sputum should be known to cytologists because of the morphologic resemblance to Entamoeba histolytica, a pathogenic amoeba. Morphologic features are described to differentiate E. gingivalis from similar structures found in sputum.

J Biol Buccale. 1981 Jun;9(2):155-61.

[Protozoa of the human oral cavity (epidemiological correlations and pathogenic possibilities].

Feki AMolet BHaag RKremer M.


The oral protozoa frequency has been studied in 300 patients consulting for oral problems. Entamoeba gingivalis has been isolated more frequently in culture than Trichomonas tenax (50.7% against 28%). The age range which showed the highest frequency in protozoa was the 30-34 year old group for the amoeba and the 45-54 year old group for the flagellae. The endemia increased progressively in relation to the OHIS index. Trichomonas tenax is three times more frequent in case of deep periodontal diseases whereas, Entamoeba gingivalis reached its highest frequency in the case of gingivitis. The pathogenic potentials of these protozoa have been discussed in the light of these correlations and some therapeutical arguments.

Pathol Biol (Paris). 1979 Dec;27(10):603-6.

[A study of the frequency of protozoa and yeasts isolated from the parodontium of 509 subjects (author’s transl)].

Cambon MPetavy AFGuillot JGlandier IDeguillaume JCoulet M.


The protozoa Entamoeba gingivalis and Trichomonas tenax together with yeasts of the genus Candida were investigated in the mouth (gums or neck of tooth) of 509 healthy or diabetic subjects. A study of the possible correlation between presence of these parasites and various local or general factors, showed that neither the sex, maxillo-facial anomalies nor smoking had any influence on parasite incidence. Entamoeba gingivalis was encountered in 85 per cent of subjects free from parodontopathy. Numerous factors influenced the presence of Trichomonas tenax: age, social status, alcohol consumption, dental condition and gingival pathology. Presence of Candida was associated with diabetes, poor buccal hygiene and dental condition.