EM@3AM

A 23-year-old female with no past history presents with prolonged bleeding from her tooth extraction earlier the same day. Her dentist was planning on removing all her wisdom teeth but stopped after the first extraction due to inability to achieve hemostasis. She has never experienced this kind of bleeding before but notes that recently her gums often bleed when brushing her teeth and describes her last few menstrual cycles as “heavier” than usual. She is not on any blood thinners and was adopted at birth without record of family medical history. She is stable. Tooth number 17 appears to have been extracted, and there is blood-soaked cotton balls and gauze between the buccal mucosa and the cavity where tooth 17 used to be. Upon removal of the gauze, you notice a slow oozing of blood from the extraction site. What are some of the bleeding disorders on your differential given this clinical presentation?