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.