Von Willebrand Disease and dentistry

Dental
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Von Willerbrand disease is an inherited bleeding disorder. It results from a deficiency or dysfunction of Von Willerbrand factor (VWF). This is a protein crucial for clot formation.

Symptoms of VW disease:

  • Having nose-bleeds often that are difficult to stop
  • Bleeding from gums
  • Prolonged menstrual periods
  • Bleeding after injury, dental surgery or accidents that continues for a long time
  • Prolonged bleeding of minor cuts

For dental professionals, understanding the implications of VW disease is vital. This is because routine procedures can carry increased risk of blood loss.

Dental Considerations in VW disease:

  • Pre-Treatment evaluation:
  1. obtain detailed medical history
  2. take consent with patient’s general physician before starting any routine procedure
  3. Review any current medication the patient might be taking
  • Treatment Planning:
  1. General procedures like oral prophylaxis and restorations are generally safe with proper precautions. Ensure protection of the soft tissue at all costs
  2. Try to avoid nerve blocks as much as possible, unless really required as this increases the chances of hematoma development.
  3. Desmopressin or infusion of VW factor may be indicated in cases of extraction, periodontal surgery or any other invasive procedure
  4. Have the patient rinse with chlorhexidine for atleast 2 mins before administration of nerve block
  5. extractions should be carried out as atraumatically as possible
  6. Use a soft splint to protect the socket if needed.

Reference: https://www.dentaljournal.net/assets/archives/2023/vol5issue1/5006-334.pdf

  • Post operative care:
  1. use a soft vacuum splint to cover the extraction socket if needed
  2. keep splint in place for atleast 48 hours before checking the socket. If there is any sign of bleeding, monitor regularly and replace splint every 24 hours
  3. use of afibrinolytic agents like tranexamic acid mouthwash to support clot stability
  4. Antibiotics, and supportive care like gentle hygiene and soft diet should be properly explained to the patient post procedure
  5. Avoid NSAIDs that can interfere with platelet function

Reference: https://www1.wfh.org/publication/files/pdf-1190.pdf

Preventive measures and a minimally invasive approach remain key factors for treating patients with VW disease.

How else can we as dental professionals be better prepared for managing dental emergencies in VWD?

MBH/AB

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Informative.

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Dental professionals can be better prepared by having a clear emergency protocol, including ready access to hemostatic agents, tranexamic acid, and emergency contact with the patient’s hematologist. Regular training in managing unexpected bleeding and maintaining effective communication with patients about precautions and post-operative care is also essential.