# Prevalence of _Trichomonas tenax_ in the Population Affected by Periodantal Disease--A Review
## 4 Discussion
_Entamoeba gingivails_ is typically found in the early stages of periodontitis and _Trichomonas tenax_ is associated with the progression of periodontitis [42, 64, 71, 75, 76]. The presence of _Trichomonas tenax_ is usually less common than that of _Entamoeba gingivalis_ in patients with gingivitis [27]. Associations of the flagellated protozoan with respiratory diseases have also been reported [10, 11]. The prevalence of periodontal disease depends on various factors including the level of socioeconomic status, sanitary conditions (areas with bad hygiene may have higher risks of contamination and an increased spread of microorganisms), certain lifestyle factors (such as smoking, diet rich in sugary or acidic foods), health education, access to dental care, the population's immunological status and the presence of metabolic diseases such as diabetes [86]. A proportional relationship between the frequency of occurrence of _Trichomonas tenax_ and poor oral hygiene, alcohol consumption and tobacco use has been reported by some authors [34, 37, 53]. Changes in oral ecology due to diabetes or reduced body resistance (HIV infection, treatment with immunosuppressants after organ transplantation) facilitate the reproduction of flagellate protozoa and the colonization of dental tissues [33, 69]. Patients with masticatory system disorders, particularly those with congenital diseases, may also favor the presence of oral dysbiosis [39]. A study by [PERSON] et al. showed that the incidence of buccal parasites in patients with dental prostheses was greater [68]. _Trichomonas tenax_ has also been found in peri-implantitis lesions [43]. From our analysis, it became evident that in some countries there is a notably high number of studies on the epidemiology of _Trichomonas tenax_. This is probably due to greater research interest in countries or regions where oral health problems, infectious and parasitic diseases are more prevalent. Previous research contributes to our understanding of why _Trichomonas tenax_ is tested for more in Poland, Iran and Iraq. According to the study conducted by [PERSON] et al., more than half of the adult populations in Poland and Iran suffer from periodontal disease. Additionally, Iran also has a high proportion of adolescents affected by it [87]. Factors such as low education, use of tobacco products and metabolic disorders can be considered as risk in Iran that lead to periodontitis and tooth loss in Iran. [88] [PERSON] et al. found a significant association between parasite invasion and compromised oral hygiene in Iran [59]. An online-based survey in Iraq revealed low levels of awareness about oral health and periodontitis [89]. A similar study conducted in Poland showed an insufficient knowledge about risk factors as well as the prophylaxis of periodontal disease [90]. Unlike Iran and Iraq, Poland has another demographic characteristic: a high proportion of the population is ageing, which plays a significant role in the increased incidence of dental diseases. Declining immunity in older individuals predisposes them to the development of oral and systemic pathology [70]. Additionally, we will discuss an issue that is critical to the positivity of the samples, namely the methods of detection. It is important to note that not all methods exhibit the same sensitivity and specificity. The limitations of the methods must be considered together with other factors, such as a limited number of samples, a small number of participants, and a lack of standardized protocols, which may account for the differences in the obtained results. Different methodologies have been used over the years to find _Trichomonas tenax_. The detection methods were unspecified in two studies and biochemical methods were used in one. We observed that many scientists have identified _Trichomonas tenax_ through microscopic examination, with or without pre-staining, by visualizing pear-shaped or elliptical cells with several flagella [91].