Presence and impact of bleeding from the mouth in people living with Von Willebrand's disease in Ireland

Abstract

Background: Von Willebrand Disease (vWD) is one of the most common Congenital Bleeding Disorders (CBT). Mucosal bleeding is a feature of vWD including menorrhagia, nosebleeds and bleeding from the gums. It has been documented that people with vWD and the teams that treat them believe that such gum bleeding is inevitable. There is some evidence that people with vWD do not seek care until there is a severe impact on their quality of life. There is currently little evidence available to determine whether gum bleeding in vWD is inflammatory gingivitis or indeed muco-cutaneous bleeding. The aims of this study were to investigate the impact of such bleeding and to see if there is a correlation between their subjective and objective gum bleeding measures.

Methods: N= 24 people agreed to participate in a study, which would form the baseline RCT. The data for this thesis submission was gathered between the 17th May 2018 and the 4th March 2019. Patients were assessed using self-reported validated questionnaire measuring oral health behaviours, beliefs about causation of bleeding gums (illness perception questionnaire) and impact of bleeding on oral health related quality of life. Bivariate analyses were performed assessing the association between gingival health (GI, MBPI) and plaque levels and i) self perception of bleeding ii) clinical markers for vWD (vWF AG and Rco).

Results: On analyses participants found to be less satisfied with their dental health. Majority of people suffered from toothache, sensitivity and bleeding gums. Most of the responders preferred to use mouthwash and only some dental floss to their addition to brushing. More than a half of the responders scored moderate and high in plaque score index. Majority of surveyed experienced bleeding gums very frequently, especially on brushing and flossing.

Conclusion: Poor gingival health has a negative impact on individuals with WVF. Their poor oral health related quality of life and their illness perception did not correlate with their bleeding disorder. This gingival bleeding may be a result from gingivitis, and it possibly be reversed by personalised oral hygiene instructions.