Rashidi Maybodi F., et al. J Dent Shiraz Univ Med Sci., 2016 September; 17(3): 171-176. Original Article The Effect of Nonsurgical Periodontal Therapy on Trichomonas Tenax and Entamoeba Gingivalis in Patients with Chronic Periodontitis 1 1 2 3 4 Fahimeh Rashidi Maybodi , Ahmad Haerian Ardakani , Ali Fattahi Bafghi , Alireza Haerian Ardakani , Akram Zafarbakhsh 1 Dept. of Periodontology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 2 Dept. of Parasitology & Mycology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 3 Dept. of Orthodontics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 4 Dept. of Periodontology, Shahrekord University of Medical Sciences, Shahrekord, Iran. KEY WORDS ABSTRACT Trichomonas Tenax; Statement of the Problem: Trichomonas tenax and Entamoeba gingivalis are com- Entamoeba Gingivalis; mensal protozoa which inhabit the human oral cavity. These parasites are found in Periodontitis; patients with poor oral hygiene and might be a reason for progressive periodontal dis- Parasite eases. Purpose: 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. Materials and Method: 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. Results: 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 signifi- cant in plaque (p= 0.913). Trichomonas tenax frequency in dental plaque directly relat- ed to the severity of periodontitis (r= 0.565, p≤ 0.000). In contrast, the number of Enta- moeba 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. Conclusion: Nonsurgical periodontal treatment could reduce the number of Trichomo- Received June 2015; nas Tenax and Entamoeba gingivalis in the oral environment of patients with chronic Received in revised form August 2015; Accepted December 2015; periodontitis. Corresponding Author: Zafarbakhsh A., Dept. of Periodontology, Shahrekord University of Medical Sci- ences, Shahrekord, Iran. Email: [email protected] Tel: +98-3536255881 Cite this article as: Rashidi Maybodi F., Haerian Ardakani A., Fattahi Bafghi A., Haerian Ardakani A., Zafarbakhsh A. The Effect of Nonsurgical Periodontal Therapy on Trichomonas Tenax and Entamoeba Gingivalis in Patients with Chronic Periodontitis. J Dent Shiraz Univ Med Sci., 2016 September; 17(3): 171-176. Introduction Trichomonas is also limited [4] and have been conduct- Presenting in several various clinical forms, periodonti- ed only in few countries. [5] tis is considered as one of the most widespread oral dis- Trichomonas are mostly parasitic or commensal eases. Approximately 5 to 20 percent of the world’s flagellates that live in low-oxygen environments. [6-8] population suffers from severe generalized periodontitis. T. tenax is currently considered as a member of the oral [1] Periodontal lesions contain numerous neutrophils, biofilm. [9, 10] Its prevalence in the oral cavity ranges motile bacteria, spirillae, spinning rods, and protozoa. from 4 to 53% worldwide; [11] however, in patients [2] Yet, the etiology of this multi-factorial disease is still with periodontitis; it is 3 to 4 times more than healthy unclear. The possible role of parasites in the develop- individuals. [12] Investigations have been performed on ment of periodontitis has been poorly studied. [3] Data the correlation between the prevalence of T. tenax and from previous studies about Entamoeba gingivalis and the status of periodontitis, [6, 13] which is found partic- 171 The Effect of Nonsurgical Periodontal Therapy on Trichomonas Tenax and Entamoeba Gingivalis in … Rashidi Maybodi F., et al. ularly in patients with poor oral hygiene. [13-15] It can tics, Shiraz School of Dentistry, Iran, from March to be simply transmitted through saliva, droplet spray, October 2014. Informed consent was collected from the kissing, using contaminated dishes, and drinking water. patients. The participants were screened and examined [4, 7, 11] Oral cavity is the common residence of to make sure if they met the criteria for periodontal dis- Trichomonas species; although, it is occasionally found ease. The exclusion criteria were having a history of in the respiratory tract. [16-18] The significance of its consumption of systemic antibiotics within the three presence in the respiratory tract of humans is still un- preceding months, periodontal therapy during the pre- clear. Pleuropulmonary trichomoniasis has been ob- vious six months, medications that affect the periodon- served in bare cases. [19-21] A study in Egypt (2004) tium ( such as immunosuppressives, antihypertensives, showed that the prevalence of pulmonary trichomonia- anticonvulsants, contraceptives), systemic diseases such sis was 8% (20 cases) in a total of 250 individuals. [22] as diabetes, heart disease or respiratory diseases, preg- Entamoeba gingivalis (E. gingivalis) is found in nancy, smoking or other drug abuse. A demographic the oropharynx, but rarely in the head and neck lesions. form was filled out for each individual concerning age, [23-25] This microorganism is found more common in sex, smoking habits, and medical status. patients with poor dentition, [24] periodontal disease, As previously mentioned, the aim of this study and immune suppression. [26-28] It was the first com- was to evaluate the effect of nonsurgical periodontal mensal found in the human oral cavity. [12, 29] E. gin- treatment on the frequency of T. tenax and E. gingivalis givalis lives on the surface of the teeth and gum tissues. in saliva and plaque samples [5, 7, 35] before and 3 [30] Inflammatory process produces a propitious anaer- weeks after intervention. The first follow-up should be obic environment for their growth. [31] The trophozoite considered at least 3 weeks after treatment. This inter- is measured about 10-30 µm, actively motile with mul- val is needed for tissue healing. [36] To this end, the tiple pseudopodia, the cytoplasm contains food vacuoles patients were randomly divided into the case (23 pa- with ingested bacteria, leukocytes and epithelial cells. tients) and control (23 patients) groups by a table of [29] According to some studies, this amoeba is consid- random numbers. Considering the severity of periodon- ered as an important cause of periodontal disease. [32] tal disease by evaluating the mean clinical attachment E. gingivalis is an opportunistic pathogen whose associ- loss (CAL) in the patients’ periodontium, they were ation with synergistic symbiotic bacteria may cause per- also divided into one of the two subgroups of moderate iodontal diseases in hosts with low immunity. [33-34] (CAL=3-4mm) and severe periodontitis (CAL≥5mm). Conversely, some studies have reported the gen- [36] Sampling was done in two sessions (baseline and eral presence of E. gingivalis in disease-free individuals three week after the treatment). After collecting the first which was related to the amount of calculus present on samples from all patients, the control group received the teeth. [35] As previously mentioned in several stud- only oral hygiene instructions. Scaling and root plan- ies, these parasites exist in the oral cavity and probably ning was done in case group via ultrasonic set (Wood- play a role in development of periodontal disease. Yet, pecker; China) for 20 to 60 minutes until eliminating no study has investigated the patients with moderate to deposits completely. Then face-to-face oral hygiene severe chronic periodontitis. Hence, the current study instructions were given by using a dental model. Three was designed to evaluate the effect of nonsurgical peri- weeks later, the second set of samples were prepared odontal treatment on the level of Trichomonas tenax and delivered to the lab. The examiner who studied the and Entamoeba gingivalis in dental plaques and saliva. saliva and plaque samples was blind to the groupings throughout the study. Materials and Method Dental plaque was collected from the teeth sur- In this randomized clinical trial (#IRCT2014071013167 faces by using sterile curettes (Gracey curette #13-14). N4), 46 patients with moderate to severe chronic perio- Non-stimulated saliva (0.1 ml) was collected by using dontitis (according to the Periodontology Association in sterile pipettes (Hirschmann graduated pipette; Class 1998) and the age range of 30-50 years old were select- AS, 10 mL volume, accuracy: 0.05 mL, Germany). The ed out of those referring to the Department of Periodon- labeled smears of saliva and dental plaques were fixed 172 Rashidi Maybodi F., et al. J Dent Shiraz Univ Med Sci., 2016 September; 17(3): 171-176. with methanol and sent to the parasitology lab. Then, the abundance of parasites (signification level≤0.005). these Giemsa-stained smears were observed by using The changes in parasites abundance before and after the microscope (Nikon; Eclipse E200, Japan) at both 40X treatment were determined by using Mann-Whitney and 100X magnifications. Detection of T. tenax was test. established as a pear-shaped flagellated trophozoite of about 5-13µ (Figure 1). The other oral protozoan, E. Results gingivalis was differentiated by its size (10-20μ), pres- Out of all the 46 patients, 33 were females and 13 were ence of prominent pseudopodia and food vacuole (Fig- males. There were 29 patients with severe periodontitis ure 2). (15 cases and 14 controls), and 17 with moderate perio- dontitis (8 cases and 9 controls). The mean baseline CAL in the two groups was almost equal (case group= 5.74±1.711 mm, and control group= 5.64±1.677 mm). Generally, the frequency of T. tenax was less than E. gingivalis in both saliva and dental plaque (p≤ 0.005). The severity of periodontitis was directly related with the baseline frequency of T.