Current dental management of vWD

Preoperative
Consult the hematologist and confirm the diagnosis. Establish the variant and treatment modality. Most patients can be treated in the dental office. Those with type 3 vWD may be hospitalized. Treat any acute oral infection. Maintain good oral hygiene. Construct palatal splints for multiple extractions in patients with type 3 or type 2N variants, so that mechanical displacement of the clot in wound healing by secondary intention is prevented.[25]

Operative
Treat with DDAVP, Epsilon-aminocaproic acid or tranexamic acid, or factor VIII replacement (Humate-P or Koate-HS) prior to the procedure. Use good surgical technique. Control bleeding using local measures like gelfoam, fibrin glue, etc., Place splint (palatal).[25]

Postoperative
Examine for signs of bleeding within 24–48 h. Additional doses of DDAVP, EACA, and factor VIII are given as needed. Examine for the signs of allergy to factor VIII. Bleeding can be managed through local means; if these fail, additional systemic therapy may be needed. If infection occurs, treat by local and systemic means. Avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Acetaminophen with or without codeine may be used.[25]