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.


CONCLUSIONS
Effective periodontal treatment can be provided to patients with hemorrhagic disorders with the combined efforts of the periodontist and hematologist.
Nickles
Katrin
K
Department of Periodontology, Center for Dental, Oral, and Maxillofacial Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany. nickles@med.uni-frankfurt.de
Wohlfeil
Martin
M
Alesci
Sonja
S
Miesbach
Wolfgang
W
Eickholz
Peter
P
D000328:Adult; D016976:Aggregatibacter actinomycetemcomitans / Q000302:isolation & purification; D010520:Aggressive Periodontitis / Q000382:microbiology / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055113:Chronic Periodontitis / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D017742:Dental Care for Chronically Ill; D012534:Dental Scaling; D005164:Factor IX / Q000627:therapeutic use; D005169:Factor VIII / Q000627:therapeutic use; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication; D014148:Tranexamic Acid / Q000627:therapeutic use; D014842:von Willebrand Diseases
D000900:Anti-Bacterial Agents; D006490:Hemostatics; D014148:Tranexamic Acid; D005169:Factor VIII; D005164:Factor IX; D003894:Deamino Arginine Vasopressin