Persistent gum bleeding after dental cleaning prompts rare VWD diagnosis
Case highlights dentists’ role in spotting signs of bleeding disorders
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Persistent gum bleeding after a routine dental cleaning led to the diagnosis of a rare form of von Willebrand disease (VWD) in a woman.
The patient had a lifelong history of nosebleeds, heavy menstrual bleeding, and severe bleeding during a C-section, all of which had previously been attributed to other causes. She also had unexplained skin bruising.
“The dentist’s role in initiating this assessment—by recognizing disproportionate bleeding and systematically inquiring about past episodes and family history—is foundational to patient-centered, interdisciplinary care,” the investigators wrote.
Normal clotting tests may not rule out VWD
The authors also stressed that normal results on routine blood-clotting tests do not necessarily rule out VWD, noting that “bleeding gingiva [gums] can serve as a window to underlying hematological disorders.”
The study, “Persistent Gingival Bleeding After Scaling: A Diagnostic Clue to von Willebrand Disease,” was published in the journal Clinical Case Reports.
VWD is the most common inherited bleeding disorder, but it frequently goes undiagnosed, particularly when mild bleeding is attributed to other causes. The disease is usually caused by mutations in the VWF gene, which provides instructions for making von Willebrand factor (VWF), a protein that helps blood clot.
Researchers in China described the case of a woman whose persistent gum bleeding after a routine dental procedure led to a previously unrecognized VWD diagnosis.
The patient, age 31, underwent routine dental cleaning because of poor oral hygiene. She initially reported no systemic disease or spontaneous gum bleeding and said she knew of no family history of a bleeding disorder.
After her dental examination, she was diagnosed with localized periodontitis, a form of gum disease in which inflammation damages the tissues that support the teeth.
During ultrasonic scaling, however, substantial gum bleeding developed and persisted after 30 minutes of observation. Several measures, including compression and suturing, were used to stop the bleeding. The woman was then advised to undergo a hematological evaluation as soon as possible.
Bleeding history reveals lifelong pattern
The persistent bleeding prompted a more detailed review of her medical history, revealing a pattern of excessive bleeding dating back to childhood.
She had experienced unexplained bruising throughout her life and frequent childhood nosebleeds that could last more than 30 minutes. She also reported heavy menstrual bleeding during middle school and bleeding that lasted nearly a day after a previous dental cleaning.
During a C-section in 2022, she had substantial bleeding that required a procedure to stop it. At the time, her obstetrician attributed the bleeding to thinning or inflammation of the uterine lining. Her father also had a history of childhood nosebleeds.
Routine blood testing did not provide obvious clues. The patient’s platelet count and several standard clotting measures were within normal ranges soon after the dental procedure.
However, the woman’s VWF antigen level, which reflects the amount of VWF in the blood, was low, at 15.1%, on the fourth day after dental scaling. VWF activity was also low, at 3.3%, and the ratio of VWF activity to antigen was 0.22. These findings suggested type 2 VWD, in which VWF function is impaired.
Genetic testing identified a mutation in the VWF gene, known as p.Arg1374Cys. The mutation affects a region of VWF that helps it bind to platelets. The patient was ultimately diagnosed with type 2M/2A VWD, a rare subtype.
Family testing points to inherited bleeding risk
Testing also suggested an inherited pattern. Her son had abnormally low VWF antigen and activity levels, and testing performed later in her father showed reduced VWF antigen.
About one year later, after receiving oral hygiene guidance, the woman underwent dental scaling again, but this time without abnormal bleeding.
“This case emphasizes that even minimally invasive dental procedures can precipitate complications in patients with undiagnosed bleeding disorders, reinforcing the importance of thorough preprocedural screening and tailored, conservative dental management,” the researchers wrote.
“Key takeaways for clinical practitioners include the importance of vigilance for disproportionate bleeding, thorough assessment of systemic and family histories, and awareness of bleeding disorders,” the scientists concluded. “Dentists and other frontline clinicians must integrate this holistic perspective—looking beyond local pathology [disease]—into daily practice. By doing so, they can act as “first responders,” reducing diagnostic delay and enhancing patient-centered care.”
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