Gingival bleeding and oral hygiene in women with von Willebrand Disease (VWD): a pilot study


Introduction: Von Willebrand disease (VWD) is the most common hereditary coagulation abnormality. Individuals with VWD experience increased mucosal bleeding as well as gingival bleeding. Some evidence suggests that gingival bleeding is related to poor oral hygiene for fear of plaque removal methods that may cause bleeding to the gingival tissue. No studies have shown a correlation between VWD and gingival bleeding; however, these studies have not adjusted for possible confounding factors, such as presence of dental plaque, dental care utilisation, and oral hygiene habits. Aims: To determine the relationship between von Willebrand factor (VWF) levels and the amount of gingival bleeding, when controlling for possible confounding variables. Methods: This multi-site study included 44 women with VWD who completed a questionnaire to evaluate demographics, oral hygiene habits, perception of own oral health, oral health quality of life, and dental care utilisation. Clinical dental examinations were conducted to determine the presence of plaque and gingival bleeding on six teeth in each individual. Von Willebrand disease type and severity were determined through a medical chart review. Institutional review board (IRB) approval was obtained prior to data collection. Results: Paired sample t-tests revealed that VWF levels did not significantly affect the amount of gingival bleeding noted (p>0.05) when controlling for presence of plaque. Multiple linear regression models revealed that other factors, such as age and last dental visit (p=0.044), had a larger effect on the amount of gingival bleeding. Conclusion: In women with VWD, the presence of plaque and dental care utilisation determines gingival bleeding more than the severity of VWD.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Nichols WL, Hultin MB, James AH, et al. von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA). Haemophilia 2008; 14: 171-232.

  • 2. Mannucci PM, Federici AB, James AH, Kessler CM. von Willebrand disease in the 21st century: current approaches and new challenges. Haemophilia 2009; 15: 1154-8.

  • 3. Urdaneta MB, Urdaneta MB, Mendez VF, Socorro CB. Evaluating periodontal conditions in patients with von Willebrand’s disease in Hospital Universitario de Maracaibo (University Hospital, Maracaibo)-Venezuela. Med Oral Patol Oral Cir Bucal 2008; 13: 303-6.

  • 4. Hassan S, Qureshi W, Donthireddy V, Kuriakose P. Congenital von Willebrand’s disease and clinical hypothyroidism. Haemophilia 2013; 19: 242-5.

  • 5. Sadler JE. Von Willebrand disease type 1: a diagnosis in search of a disease. Blood 2003; 101(6):2089-93. Available from: (accessed 9 January 2017).

  • 6. Laffan M, Lester W, O'Donnell JS, et al. The diagnosis and management of von Willebrand disease: a United Kingdom Haemophilia Centre Doctors Organization guideline approved by the British Committee for Standards in Haemotology. Br J Haematol 2014; 167: 453-65.

  • 7. World Federation of Hemophilia. About bleeding disorder: von Willebrand disease, symptoms and diagnosis. May 2012. Available from: (accessed 9 January 2017).

  • 8. Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012; 91(10): 914-20.

  • 9. Löe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol 1965 Feb;36(3):177-87. Available from (accessed 9 January 2017).

  • 10. Yaacob M, Worthington HV, Deacon SA, et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev 2014; (6): CD002281. doi:

    • Crossref
    • Export Citation
  • 11. Farina R, Tomasi C, Trombelli L. The bleeding site: a multi-level analysis of associated factors. J Clin Periodontol 2013;40(8): 735-42. doi:

    • Crossref
    • Export Citation
  • 12. Trombelli L, Takatis DN, Scapoli C, et al. Modulation of clinical expression of plaque-induced gingivitis. J Clin Periodontol 2004; 31: 239-52.

  • 13. Lang NP, Cumming BR, Löe H. Toothbrushing frequency as it relates to plaque development and gingival health. J Periodontol 1973; 44: 396-405.

  • 14. Ziebolz D, Stühmer C, Hornecker E, et al. Oral health in adult patients with congenital coagulation disorders--a case control study. Haemophilia. 2011; 17: 527-31.

  • 15. Archer WH, Subrow HJ. Fatal hemorrhage following regional anesthesia for operative dentistry in a hemophilic. Oral Surg Oral Med Oral Pathol 1954; 7: 464-70.

  • 16. Gupta A. Bleeding disorders of importance in dental care and related patient management. J Can Dent Assoc 2007; 73: 77-83.

  • 17. Wallak MB. Periodontal therapy for a patient with von Willebrand’s disease a case report. J Periodontol 1972; 43: 495-501.

  • 18. Eberhard J, Grote K, Luchtefeld M, et al. Experimental gingivitis induces systemic inflammatory markers in young healthy individuals: a single-subject interventional study. PLoS One. 2013;8:e55265. doi:

    • Crossref
    • Export Citation
  • 19. Pizzo G, Guiglia R, Licata ME, et al. Effect of hormone replacement therapy (HRT) on periodontal status of postmenopausal women. Med Sci Monit 2011; 17: PH23-7.

  • 20. Chen YC, Yang L, Cheng SN, et al. von Willebrand disease: a clinical and laboratory study of sixty-five patients. Ann Hematol 2011; 90: 1183-90.

  • 21. Taichman LS, Eklund SA. Oral contraceptives and periodontal diseases: rethinking the association based upon analysis of National Health and Nutrition Examination Survey data. J Periodontol 2005; 76: 1374-85.

  • 22. Weickert L, Miesbach W, Alesci SR, Eickholz P, Nickles K. Is gingival bleeding a symptom of patients with type 1 von Willebrand disease? A case-control study. J Clin Periodontol 2014; 41(8): 766-71. doi:

    • Crossref
    • Export Citation

Journal + Issues