Role of Oral Physician in Organ Transplant: Bridging a Gap in Indian Healthcare
Year: 2025
Type: article
Abstract: Dear IAOMR members, Greetings from the Editorial Team With a profound sense of obligation and heartfelt appreciation, I present the second issue of the Volume 37 (2025). The obligation is towards the JIAOMR readers and heartfelt appreciation toward the contributors i.e. the authors, the reviewers, and the editorial team. The ‘World Organ Donation’ day will be observed on the 13 August 2025. This day is globally recognized as a day dedicated to raising awareness and to encourage organ donation to save lives. In India, the ‘Transplantation of Human Organs Act’ was passed in parliament in 1994 that legalised and regulated the transplantation of solid organs.[1] Organ transplantation represents one of the greatest triumphs of modern medicine. With advancement in medical science, we have witnessed improvement in the transplant success rate. However, undeniably, new challenges have emerged; one of the most overlooked being post-transplantation changes in oral health and vice versa as oral health directly impacts the transplant outcomes. Immunosuppressive therapy that is a cornerstone of transplant success, renders patients highly susceptible to infections, malignancies and delayed wound healing.[2] Chronic oral infections such as periodontitis, dental abscesses and mucosal pathologies if left untreated, can become life-threatening sources of systemic infection. This can lead to jeopardizing the transplanted organ and patient survival. Despite these challenges, oral health remains a neglected component in many transplant protocols across the nation. In this context, the role of an Oral Physician, the Oral Medicine and Radiology (OMR) specialist has become increasingly significant, yet often under-recognized. PRE-TRANSPLANTATION CONSIDERATIONS Pre-transplantation consideration is often referred to as ‘Clearance’ and includes a through comprehensive evaluation of the recipient before transplantation, ensuring the elimination of potential foci of infection. The concern being the sites of asymptomatic infections may flare up, while the patient is immunosuppressed or hospitalised for the transplant procedure. OMR specialists are trained extensively in diagnosing, managing, and preventing complex oral diseases, especially in medically compromised patients. Along with detailed clinical examination, a screening panoramic radiograph is often advisable to study the periodontium, as well as to rule out any bony changes due to chronic systemic disorders, such as renal osteodystrophy in chronic kidney disease. The treatment plan for the recipients should be determined based on the period of immunosuppression, and with regular coordination with the Transplant team. During this stage, the patient and/or their relatives should be advised to follow-up with the dental team periodically, since there may be an extended waiting period until the actual date of transplant. POST-TRANSPLANTATION CONSIDERATIONS Oral physicians also play a crucial role in managing post-transplant complications. This is divided into the immediate period, stable period, and chronic rejection period. No elective dental treatment should be performed during the immediate period. Only emergency treatment should be provided after consultation with the transplantation physician. Post-transplant patients frequently present with oral candidiasis, herpes simplex reactivations, and drug-induced gingival hyperplasia (particularly with cyclosporine therapy).[3] More concerning is the heightened risk of oral squamous cell carcinoma due to chronic immunosuppression.[4] Early recognition and management of these conditions by a trained Oral Medicine specialist can make a significant difference in patient survival and quality of life. Furthermore, OMR specialists understand the pharmacological nuances required, when managing these patients, considering potential drug interactions and altered immune responses. PRACTICE WHAT YOU PREACH A shining example of such interdisciplinary collaboration can be seen at Goa Dental College and Hospital, Bambolim, Goa where an Oral Medicine specialist has been actively integrated into the transplant board. This specialist attends weekly joint clinics in Goa Medical College alongside transplant surgeons, nephrologists, hepatologists, gynaecologists, psychologists, etc., contributing expertise during preparing the recipient before transplant and in the management of oral complications in transplant patients. The participation of the OMR specialist has not only improved the management of oral complications, but has also enhanced overall transplant outcomes by ensuring a comprehensive approach to patient care. FUTURE RECOMMENDATIONS Moving forward, it should be a top priority to formally integrate OMR specialists into all transplant care clinics. Hospitals and transplant boards must establish clear protocols mandating pre-transplant oral evaluations, regular oral health monitoring post-transplant and close communication between transplant teams and Oral Medicine units. In other words, a Multidisciplinary Transplant Board should not be considered complete without the active participation of an Oral Medicine specialist. Our unique training bridges the gap between dentistry and medicine, enabling us to contribute significantly to the multidisciplinary care of transplant patients. Additionally, educating transplant candidates about the importance of oral health maintenance should be an integral part of pre- and post-transplant counselling. Research collaborations between transplant teams and OMR departments are also the need of the hour. There is a pressing need for evidence-based guidelines tailored specifically to the oral care of transplant recipients. In conclusion, oral health is inseparable from systemic health, particularly in Transplant Medicine. As the transplant community evolves in India, recognizing and embracing the Oral Medicine and Radiology specialist as an essential partner is not just desirable—it is indispensable. We as Oral Medicine specialists should move forward, collaborate and walk hand in hand with the transplant medicine fraternity to truly achieve holistic patient care.
Author: Manisha M. Khorate
Institution: Goa Dental College and Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411714995