J Haem Pract 2017; 4(1):1-9. doi: 10.17225/jhp00096

Authors: Stefanie VanDuine, Jill Bashutski, Mark Snyder, L. Susan Taichman

Stefanie VanDuine
Department of Periodontics and Oral Medicine, School of Dentistry,, University of Michigan, Ann Arbor, MI.. Email:

Jill Bashutski
Department of Periodontics and Oral Medicine, School of Dentistry, , University of Michigan, Ann Arbor, MI..

Mark Snyder
Department of Biologic and Materials Science, University of Michigan, Ann Arbor, MI.

L. Susan Taichman
Department of Periodontics and Oral Medicine, School of Dentistry, , University of Michigan, Ann Arbor, MI.


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.


S. VanDuine, K. Ridley, and LS. Taichman designed the research. S. VanDuine and K. Ridley collected data. S. VanDuine analysed data. C. Powell provided statistical guidance for data analysis. S. VanDuine drafted the manuscript. M. Snyder provided guidance on research design and interpretation. LS. Taichman, J. Bashutski, and K. Ridley provided editorial guidance. All authors collaborated and approved the final version of this manuscript.
We thank the University of Michigan Hematology and Coagulation Disorders Clinic, Michigan State University Center for Bleeding and Clotting Disorders, and Michigan Center for Oral Health Research. A Rackham Graduate School Research Grant supported this study. Authors declare no competing financial interests. The authors also state that theyhave no interests that may be perceived as posing a conflict or bias.




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