Gingival bleeding and mild type 1 von Willebrand disease.

Oral bleeding is a frequently reported symptom of von Willebrand disease (VWD) and evaluated by several VWD bleeding scores. Gingival bleeding is also known to be a leading symptom of plaque-induced gingivitis and untreated periodontal disease. This study evaluates whether mild type 1 VWD is associated with an increased susceptibility to gingival bleeding. In this case-control study, 50 patients and 40 matched controls were periodontally examined, answered a questionnaire, and underwent professional teeth cleaning. Compared with the controls, the VWD patients more frequently reported periodontal symptoms, such as bleeding (34 vs. 20%, P = 0.141) and swelling (54 vs. 32.5%, P = 0.538) of the gingiva, and these patients had their teeth professionally cleaned less often (58 vs. 77.5%, P = 0.051). However, there was less gingival bleeding, as determined by the gingival bleeding index, in the VWD patients compared with the controls (10 vs. 12.2%, P = 0.047); the amount of bleeding on probing was similar between the VWD patients and the controls (17 vs. 17.2%, P = 0.723). Gingival bleeding in VWD patients may be triggered by gingival inflammation, but it is not a genuine symptom of mild type 1 VWD.

Is gingival bleeding a symptom of patients with type 1 von Willebrand disease? A case-control study.

BACKGROUND: Von Willebrand disease (VWD) is the most common inherent bleeding disorder resulting in prolonged bleeding time. Gingival bleeding is a frequently reported symptom of VWD. However, gingival bleeding is also known as a leading symptom of plaque-induced gingivitis and untreated periodontal disease. Gingival bleeding in VWD patients (VWD) may be triggered by gingival inflammation and not a genuine symptom. Thus, this study evaluated whether type 1 VWD determines an increased susceptibility to gingival bleeding in response to the oral biofilm. METHODS: Fifty cases and 40 controls were examined haematologically (VWF antigen, VWF Ristocetin cofactor, factor VIII activity) and periodontally [Gingival Bleeding Index (GBI), bleeding on probing (BOP), Plaque Control Record (PCR), periodontal inflamed surface area (PISA), vertical probing attachment level]. RESULTS: GBI was significantly higher in controls (12.2%) than in VWD (10%). The study failed to find a significant difference regarding BOP between VWD (17%) and controls (17.2%). Multiple regressions identified PCR and PISA to be associated with GBI and BOP. VWD was negatively associated with GBI. Smoking and number of remaining teeth was negatively associated with BOP. CONCLUSION: VWD is not associated with a more pronounced inflammatory response to the oral biofilm in terms of GBI and BOP.