Comprehensive Treatment Of Periodontitis In Patients With Von Willebrand Disease

Background: Hemophilia A and B and von Willebrand disease (VWD) belong to the most frequent congenital coagulation disorders and are a significant problem in patients who require periodontal therapy or tooth extraction. These patients need specialist management because even minor invasive procedures can precipitate a prolonged bleeding episode. However, although dental care presents major challenges in these patients, only a few studies are available.Methods: In this case series, the comprehensive periodontal treatment of four patients with hemorrhagic disorders (VWD type I and mild hemophilia B) is described. There was a close collaboration between the periodontist and the hematologist: all patients were scheduled for premedication with desmopressin and other pharmaceuticals at the hematologist's office. After one session of scaling and root planing was performed in all patients, local agents such as tranexamic acid were used. In the course of periodontal therapy, access-flap surgery was performed in one of the four patients.Results: Before treatment, the rates of probing depths (PDs) of 4 to 6 mm (20% to 57%) or >= 7 mm (2% to 20%) were high. Three months after treatment, the rates of PDs of 4 to 6 mm (5% to 42%) or >= 7 mm (0% to 2%) decreased significantly in all patients. Attachment gains were also observed. A secondary hemorrhage did not occur in any of the patients, and wound healing proceeded without any complications.Conclusion: Effective periodontal treatment can be provided to patients with hemorrhagic disorders with the combined efforts of the periodontist and hematologist. J Periodontol 2010;81:1432-1440.