Statement of Principles
concerning
DENTAL CARIES
(Balance of Probabilities)
(No. 123 of 2015)
The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans’ Entitlements Act 1986.
 
 
Dated    16 October           2015
 
 
 
 
 
The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:
 
 
 
 
Professor Nicholas Saunders AO
Chairperson
 
 
 
  
Contents
1          Name........................................................................................................................................... 3
2          Commencement........................................................................................................................ 3
3          Authority..................................................................................................................................... 3
4          Revocation................................................................................................................................. 3
5          Application................................................................................................................................. 3
6          Definitions.................................................................................................................................. 3
7          Kind of injury, disease or death to which this Statement of Principles relates............... 3
8          Basis for determining the factors........................................................................................... 4
9          Factors that must exist............................................................................................................. 4
10        Relationship to service............................................................................................................. 5
11        Factors referring to an injury or disease covered by another Statement of Principles. 5
Schedule 1 - Dictionary............................................................................................. 6
1          Definitions.................................................................................................................................. 6
 
 
 
1               Name
This is the Statement of Principles concerning dental caries (Balance of Probabilities) (No. 123 of 2015).
2               Commencement
This instrument commences on 16 November 2015.
3               Authority
This instrument is made under subsection 196B(3) of the Veterans’ Entitlements Act 1986.
4               Revocation
The Statement of Principles concerning dental caries No. 72 of 2007 made under subsection 196B(3) of the VEA is revoked.
5               Application
This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.
6               Definitions
The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.
7               Kind of injury, disease or death to which this Statement of Principles relates
(1)          This Statement of Principles is about dental caries and death from dental caries.
Meaning of dental caries
(2)          For the purposes of this Statement of Principles, dental caries means the localised destruction of susceptible dental hard tissues by acidic by-products from bacterial fermentation of dietary carbohydrates, leading to decalcification or cavity formation.
(3)          While dental caries attracts ICD‑10‑AM code K02.0, K02.1, K02.2, K02.3, K02.5, K02.8 or K02.9, in applying this Statement of Principles the meaning of dental caries is that given in subsection (2).
(4)          For subsection (3), a reference to an ICD‑10‑AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.
Death from dental caries
(5)          For the purposes of this Statement of Principles, dental caries, in relation to a person, includes death from a terminal event or condition that was contributed to by the person’s dental caries.
Note: terminal event is defined in the Schedule 1 – Dictionary.
8               Basis for determining the factors
On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that dental caries and death from dental caries can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.
Note: relevant service is defined in the Schedule 1 – Dictionary.
9               Factors that must exist
At least one of the following factors must exist before it can be said that, on the balance of probabilities, dental caries or death from dental caries is connected with the circumstances of a person’s relevant service:
(1)          being exposed to fermentable dietary carbohydrates as specified for a continuous period of at least three months, within the two years before the clinical onset of dental caries;
Note: being exposed to fermentable dietary carbohydrates as specified is defined in the Schedule 1 - Dictionary.
(2)          smoking at least six pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of dental caries, and where smoking has ceased, the clinical onset of dental caries has occurred within five years of cessation;
Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
(3)          inability to obtain exposure to fluoride on more days than not for a continuous period of at least one year, within the five years before the clinical onset of dental caries;
Note: exposure to fluoride is defined in the Schedule 1 - Dictionary.
(4)          inability to perform effective personal dental hygiene for a continuous period of at least three months, within the two years before the clinical onset of dental caries;
(5)          inability to access preventive professional dental care, including regular cleaning and application of fluoride, at least every 15 months, within the five years before the clinical onset of dental caries;
(6)          having hyposalivation as a result of a course of therapeutic radiation to the head or neck, for at least the four weeks before the clinical onset of dental caries;
Note: hyposalivation is defined in the Schedule 1 - Dictionary.
(7)          having xerostomia for a continuous period of at least three months, within the two years before the clinical onset of dental caries;
Note: xerostomia is defined in the Schedule 1 - Dictionary.
(8)          having an acquired enamel defect of the affected tooth for at least the three months before the clinical onset of dental caries;
Note: acquired enamel defect is defined in the Schedule 1 - Dictionary.
(9)          for root surface caries only, having gingival recession of the affected tooth for at least the three months before the clinical onset of dental caries;
Note: gingival recession is defined in the Schedule 1 - Dictionary.
(10)      inability to obtain appropriate clinical management for dental caries.
10           Relationship to service
(1)          The existence in a person of any factor referred to in section 9 must be related to the relevant service rendered by the person.
(2)          The factor set out in subsection 9(10) applies only to material contribution to, or aggravation of, dental caries where the person’s dental caries was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
11           Factors referring to an injury or disease covered by another Statement of Principles
In this Statement of Principles:
(1)          if a factor referred to in section 9 applies in relation to a person; and
(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;
then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
 
 
Schedule 1 - Dictionary  
Note: See Section 6
1               Definitions
 In this instrument:
                               acquired enamel defect means abnormal loss of tooth substance due to trauma, abrasion or erosion.
                               being exposed to fermentable dietary carbohydrates as specified means exposure of the teeth to fermentable dietary carbohydrates, either continuously over a period of at least six hours per day, or on at least ten separate occasions per day with more than 30 minutes between exposures.
Note: fermentable dietary carbohydrates is also defined in the Schedule 1 - Dictionary.
                               dental caries—see subsection 7(2).
exposure to fluoride means application of fluoride to the teeth in one of the following forms:
(a)           fluoridated drinking water in locations with low naturally-occurring fluoride concentration in the water supply;
(b)          fluoridated toothpaste with a fluoride concentration of at least 1 000 parts per million; or
(c)           liquid, tablet or lozenge formulation.
                               fermentable dietary carbohydrates means sugars or heat-processed starch which can be converted by oral bacteria to acids.
                             gingival recession means the loss of gum tissue from the base of a tooth with exposure of the root surface.
                               hyposalivation means an abnormally reduced salivary flow, to a resting whole saliva flow rate of 0.1 ml/minute or less, or to a stimulated whole saliva flow rate of 0.5 ml/minute or less.
                               MRCA means the Military Rehabilitation and Compensation Act 2004.
                             pack-years of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes.  One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight.  One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight.  Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.
                             relevant service means:
(a)           eligible war service (other than operational service) under the VEA;
(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or
(c)           peacetime service under the MRCA.
                             terminal event means the proximate or ultimate cause of death and includes the following:
(a)           pneumonia;
(b)          respiratory failure;
(c)           cardiac arrest;
(d)          circulatory failure; or
(e)           cessation of brain function.
                             VEA means the Veterans' Entitlements Act 1986.
                             xerostomia means dry mouth resulting from severely reduced saliva flow and which results from various medical conditions, including Sjogren's syndrome, or a wide variety of drugs, including anticholinergics, tricyclic antidepressants and amphetamines.