# The Presence of Periodontitis in Patients with Von Willebrand Disease: A Systematic Review  
[PERSON]  
1 Department of Oral Health, University of Medicine and Pharmacy, Iuliu Hatieganu, 400012 Cluj-Napoca, Romania; [EMAIL_ADDRESS] (A.M.); [EMAIL_ADDRESS] (O.L.) [PERSON]  
2 Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy; [EMAIL_ADDRESS]  
[PERSON]  
3 Department of Maxillofacial Surgery and Implantology, University of Medicine and Pharmacy, Iuliu Hatieganu, 400012 Cluj-Napoca, Romania; [EMAIL_ADDRESS] (M.B. ); [EMAIL_ADDRESS] (S.B. ); [EMAIL_ADDRESS] (G.B. ); [EMAIL_ADDRESS] (H.O. ); [EMAIL_ADDRESS] (O.A.P. ); [EMAIL_ADDRESS] (F.O);  
3 Department of Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy; [EMAIL_ADDRESS]  
[PERSON]  
3 Department of Maxillofacial Surgery and Implantology, University of Medicine and Pharmacy, Iuliu Hatieganu, 400012 Cluj-Napoca, Romania; [EMAIL_ADDRESS] (M.B. ); [EMAIL_ADDRESS] (S.B. ); [EMAIL_ADDRESS] (G.B. ); [EMAIL_ADDRESS] (H.O. ); [EMAIL_ADDRESS] (O.A.P. ); [EMAIL_ADDRESS] (F.O);  
4 Department of Hematology, University of Medicine and Pharmacy, Iuliu Hatieganu, 400012 Cluj-Napoca, Romania; [EMAIL_ADDRESS] (C.T. ); [EMAIL_ADDRESS] (S.P)  
5 Department of Medical Oncology, University of Medicine and Pharmacy, Iuliu Hatieganu, 400012 Cluj-Napoca, Romania; [EMAIL_ADDRESS]  
6 Department of Dental Materials, University of Medicine and Pharmacy, Iuliu Hatieganu, 400012 Cluj-Napoca, Romania  
7  
6  
7  
8  
9  
10  
11  
12  
13  
14  
15  
16  
17  
18  
19  
2021  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
Von Willebrand disease (VWD) is known as the most common genetic hemorrhagic disorder [4, 5], determined by the anomaly in the quality or quantity of von Willebrand factor (VWF):  
**Type 1. ** A quantitative deficiency of VWF, the most common autosomal dominant form. **Type 2. ** A qualitative alteration of VWF synthesis, which can result from various genetic abnormalities with autosomal dominant inheritance. **Type 3. ** A rare autosomal recessive disease in which homozygotes have no detectable von Willebrand factor activity. VWF is an adhesion glycoprotein, with multiple roles in the process of coagulation. The most important role of this glycoprotein is to adhere to coagulation factor VIII, platelets and damaged subendothelium [5], as reported in Figure 1. Clinical signs of von Willebrand disease include nasal, conjunctival, or oral mucosal bleeding [4, 5, 6], persistent bleeding after minor trauma or dental extractions [7], excessive blood loss during menstrual periods [8], or bleeding of the gastrointestinal mucosa [9]. Among other systemic conditions that can coexist with periodontal disease, hemophilia expressed by VWD is known to affect the periodontal tissue [10]. Subsequently, the hemorrhagic risk is important not only in the manifestations of periodontal disease itself, but also during the periodontal treatment. Patients undergoing periodontal treatment measurements would benefit from specific therapeutic approaches, with the goal of diminishing the occurrence of prolonged bleeding times. Surgical and nonsurgical periodontal treatment must be performed in collaboration with the hematologist, in order to meet all the complex requirements of patients with hematological pathologies [10]. Procedures of bone and graft reconstruction must have constrained indications, even though modern technologies and equipment are nowadays available. Treatment measurements must be redirected to substitute procedures that are able to minimize the hemorrhagic risk [11]. The dental management of patients with VWD must focus on preventive measures in order to decrease the occurrence of periodontal pathologies. The avoidant brushing behavior of patients must also be taken into consideration, given their concerns not to self-cause gingival hemorrhages [12].