In Order to Receive Lifesaving Treatment, Patients Must Go to the Dentist: CDM Faculty Member Screens Transplant Candidates for Oral Health

On television medical shows, organ transplants are the stuff of high drama. Patients are alerted to available organs by beepers; hearts, livers and kidneys are loaded onto charter flights and delivered to transplant centers where patients are prepped for emergency surgery.

But in real life, before patients can undergo organ transplant or begin a regimen of chemotherapy, they must go through a comprehensive, pre-procedure medical clearance

evaluation. This battery of tests and consultations designed to evaluate various aspects of the patient's physical and mental health is essential to assess suitability for the procedure, identify potential risks, and optimize patient health for successful outcomes.

At Columbia University Irving Medical Center, transplant candidates and patients embarking on a course of chemotherapy are evaluated by a team of specialists prior to being added to the transplant lists or receiving cancer treatment — screenings can include assessments of heart, lungs, liver, and kidneys.

In addition, candidates for transplant and cancer treatments must obtain a dental clearance because good oral health can minimize opportunistic infections. At CUIMC, Laila Akhlaghi, DDS, MS, a member of the faculty of the College of Dental Medicine, serves as the point person for patients in need of oral screening.

Akhlagi says she came to Columbia specifically to do this work. “I already had created a clinic [to do pre-transplant oral screenings] in London,” she says. Because she is able to work directly with the medical team, patients don’t get lost in what she says can be a large and intimidating bureaucracy.

Because general practice dentists are often reluctant to treat patients with failing organs or life-threatening cancers, the patients Akhlaghi and her colleagues see are often in need of an enormous amount of dental work that must be done quickly, usually under general anesthesia. The goal is to stabilize and/or remove existing and potential sources of infection and irritation in the oral cavity.

“When I came to Columbia, I told the [transplant] teams that I want to be contacted directly for every single case,” she says. Akhlaghi then serves as a sort of traffic cop, treating some patients herself or diverting them to other doctors and residents from the general practice residency program, where Akhlaghi is a member of the faculty, or other departments including oral surgery and endodontics. “I create the pathways so that patients are seen and don't get lost in the system.”  

Akhlaghi says that pre-transplant oral screenings are imperative. “If you have an active dental infection, you will most probably end up rejecting the organ,” she says. Transplant patients are immunocompromised by design so that they don’t reject implanted organs. Bacteria from oral infections can travel throughout the body. Patients receiving immunosuppression therapy are without the body’s natural defenses against infection and infection can go unchecked.

Akhlaghi says that a recent patient, a 32-year-old woman in need of a liver transplant, required six extractions and eight fillings. “She was a good candidate,” Akhlaghi says. “She was healthy, had no other issues apart from a fading liver that she’d been born with.” Without the oral health assessment and treatment that Akhlaghi provided, she would not have been a candidate for transplant.

The collaboration between the transplant team and Akhlaghi’s team is resulting in new processes that will, Akhlaghi hopes, create better systems for treatment. Akhlaghi says that Epic, the electronic health record system, has been a game changer. “We are able to organize things in a much more patient-focused way.”

Akhlaghi, who was in private practice in London, says she developed an interest in this work because her husband, a pediatric neuro-oncologist, would ask her to see his patients. She was reluctant but he was insistent. “And once I got into it, it was so satisfying, helping people. Because this is not just, ‘I'm going to do a crown for you and improve your status.’ This is, ‘I'm going help you save your life.’”