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Gum Bleeding in Low Von Willebrand Factor- What’s the Score?

1Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland, 2St James's Hospital, National Coagulation Centre, Dublin, Ireland, 3Dublin Dental University Hospital, Dublin, Ireland, 4RCSI, Irish Centre for Vascular Biology, Dublin, Ireland

Abstract Number: PB1595

Meeting: ISTH 2020 Congress

Theme: Platelet Disorders and von Willebrand Disease » VWF and von Willebrand Factor Disorders - Clinical Conditions

Background: Bleeding Assessment Tools (BAT) have standardized phenotypic evaluation for bleeding disorders (BD) incorporating oral cavity (PO) bleeding. PO bleeding was previously reported in 48% (76/159) of adults in the Low Von Willebrand in Ireland Cohort (LoVIC) study.

Aims: We investigated whether PO bleeding was related to Low Von Willebrand Factor (VWF) or underlying gingivitis.

Methods: Patients with Low VWF were enrolled and diagnostic ISTH BAT scores recorded. Dental staff, blinded to the ISTH BAT, used objective dental measures to assess gum bleeding (Modified Papillary Bleeding Index [MPBI]), gingivitis (Gingival index [GI]) and plaque burden (Quigley-Hein Index [QHI]). All received hygienist-led standardized but personalized information session on oral hygiene and reassessed 4-6 weeks later. Data analysis was performed using Prism 8 software.

Results: 30 patients with Low VWF levels enrolled (median age 41 years, 90% female). 80% of patients enrolled reported PO cavity bleeding, with 13% requiring consultation. Median MPBI (6, range 0-29), GI (0.72, range 0.16-2) and QHI scores (1.18, range 0.35-2.38) were elevated at baseline. Objective dental bleeding (MBPI) correlated poorly with either the total ISTH BAT (r2=0.006) or PO domain (r2=0.06) scores. In all individuals, a personalised oral hygiene intervention resulted in highly significant reductions in objective bleeding (MBPI median 7 to 1, p< 0.0001; GI 0.72 to 0.25, p< 0.0001) and plaque scores (QHI 1.18 to 0.67 p< 0.0001).

Conclusions: The current oral cavity bleeding component of ISTH BAT lacks specificity for BD and may reinforce perceptions that bleeding is related to BD rather than gingivitis. Gingivitis is common and untreated gingival disease may progress to periodontitis with associated systemic impacts, tooth loss and reduced oral function; delays in recognition should be avoided. The ISTH BAT correlated poorly with objective dental measures of bleeding (MPBI, GI), suggesting limited benefit of this domain for physicians and dentists alike.

To cite this abstract in AMA style:

Dougall A, Parkinson L, Anishchuk S, Nolan M, Ryan K, O'Connell N, Lavin M, O'Donnell J, Daly B. Gum Bleeding in Low Von Willebrand Factor- What’s the Score? [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/gum-bleeding-in-low-von-willebrand-factor-whats-the-score/. Accessed October 1, 2023.

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