Coordinated dental management in a patient with von Willebrand Disease

Celak, Dominic, Takako Tanaka, Rose Geist, and Angela Lambing

Background:  von Willebrand Disease (vWD) is the most common hereditary bleeding disorder. Severity of bleeding tendency varies depending on the subtype (deficiency of quantity or quality of von Willebrand Factor (VWF)).  Diagnosis can be lengthy and complex; however, it is crucial for adequate treatment of bleeding episodes. Usually patients with vWD are diagnosed and treated in a hemophilia treatment center (HCT) sponsored by CDC.  When a vWD patient seeks dental surgical care, hemostasis is an obvious concern. It is important for dental care providers to recognize the complexity of this disease and communicate with medical providers.  Coordination with the patient’s hematologic specialty team not only optimizes the efficiency of dental care but minimizes healthcare cost. Most importantly it provides a sense of security, which can reduce patient anxiety.

 

Case summery: A 60-year-old male patient with vWD was referred to our clinic from HTC at Henry Ford Hospital (HF) in Detroit, Michigan. He complained of “ongoing dental infection” for many years and wanted to have comprehensive dental care that many dentists hesitated to provide. He stated that he has been avoiding dental care due to this “bad experiences”. Oral examination revealed multiple carious teeth, several of them decayed to the roots resulting in chronic apical periodontitis. The patient was diagnosed as vWD Type 2N, a subtype with a marked decline in the binding affinity for factor VIII.  Several extractions were performed three hours after patient received Humate-P® (vWF/FVIII concentrate) infusion at HF.  Hemostasis was achieved without further intervention. The patient continues to receive comprehensive dental care safely and satisfactorily.

Conclusion:This case illustrates how medical-dental inter-professional coordination can provide efficient dental care, reduce healthcare costs, and significantly improve the quality of life for patients with bleeding disorders.