Statement of Principles concerning dental pulp and apical disease No. 3 of 2014

Link to law: https://www.comlaw.gov.au/Details/F2014L00014

 
Statement of Principles
concerning
 
DENTAL PULP AND APICAL DISEASE
No. 3 of 2014
 
for the purposes of the
 
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
Title
1.         This Instrument may be cited as Statement of Principles concerning dental pulp and apical disease No. 3 of 2014.
Determination
2.         The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 73 of 2002 concerning dental pulp disease; and
(b)        determines in its place this Statement of Principles.
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about dental pulp and apical disease and death from dental pulp and apical disease.
(b)               For the purposes of this Statement of Principles, "dental pulp and apical disease" means inflammation, infection, necrosis or degeneration of the pulp of the teeth and pulp-related pathological changes involving the apices of the teeth.  This definition of dental pulp disease includes apical abscess, acute and chronic apical periodontitis and apical cyst, but excludes combined periodontic-endodontic lesions.  Apical abscess is also known as endodontic or dentoalveolar abscess.
(c)                Dental pulp and apical disease attracts ICD-10-AM code K04.0, K04.1, K04.2, K04.3, K04.4, K04.5, K04.6, K04.7 or K04.8.
(d)               In the application of this Statement of Principles, the definition of "dental pulp and apical disease" is that given at paragraph 3(b) above.
Basis for determining the factors
4.         The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that dental pulp and apical disease and death from dental pulp and apical disease can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).
Factors that must be related to service
5.         Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.
Factors
6.         The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting dental pulp and apical disease or death from dental pulp and apical disease with the circumstances of a person’s relevant service is:
(a)                having dental caries in the affected tooth immediately before the clinical onset of dental pulp and apical disease; or
(b)               having periodontitis in the periodontium supporting the affected tooth immediately before the clinical onset of dental pulp and apical disease; or
(c)                having trauma to the region of the affected tooth within the five years before the clinical onset of dental pulp and apical disease; or
(d)               having a blunt injury to the supporting structures of the affected tooth without abnormal loosening or displacement of the tooth, but with marked tenderness to percussion of the affected tooth, within the two years before the clinical onset of dental pulp and apical disease; or
(e)                undergoing dental or orthodontic surgery to the region of the affected tooth within the one year before the clinical onset of dental pulp and apical disease; or
(f)                undergoing a noninvasive dental or orthodontic procedure involving the affected tooth or the periodontium supporting the affected tooth, within the one year before the clinical onset of dental pulp and apical disease; or
(g)               smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of dental pulp and apical disease, and where smoking has ceased, the clinical onset of dental pulp and apical disease has occurred within ten years of cessation; or
(h)               having diabetes mellitus at the time of the clinical onset of dental pulp and apical disease; or
(i)                 having dental caries in the affected tooth immediately before the clinical worsening of dental pulp and apical disease; or
(j)                 having periodontitis in the periodontium supporting the affected tooth immediately before the clinical worsening of dental pulp and apical disease; or
(k)               having trauma to the region of the affected tooth within the five years before the clinical worsening of dental pulp and apical disease; or
(l)                 having a blunt injury to the supporting structures of the affected tooth without abnormal loosening or displacement of the tooth, but with marked tenderness to percussion of the affected tooth, within the two years before the clinical worsening of dental pulp and apical disease; or
(m)             undergoing dental or orthodontic surgery to the region of the affected tooth within the one year before the clinical worsening of dental pulp and apical disease; or
(n)               undergoing a noninvasive dental or orthodontic procedure involving the affected tooth or the periodontium supporting the affected tooth, within the one year before the clinical worsening of dental pulp and apical disease; or
(o)               smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of dental pulp and apical disease, and where smoking has ceased, the clinical worsening of dental pulp and apical disease has occurred within ten years of cessation; or
(p)               having diabetes mellitus at the time of the clinical worsening of dental pulp and apical disease; or
(q)               inability to obtain appropriate clinical management for dental pulp and apical disease.
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(i) to 6(q) apply only to material contribution to, or aggravation of, dental pulp and apical disease where the person’s dental pulp and apical disease was suffered or contracted before or during (but not arising out of) the person’s relevant service.
Inclusion of Statements of Principles
8.         In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
Other definitions
9.         For the purposes of this Statement of Principles:
"a noninvasive dental or orthodontic procedure" means the therapeutic application of a chemical substance, heat or cold, or a physical force to the surface of the teeth, occurring during the course of dental or orthodontic treatment;
"apical abscess" means a destructive process in the bony and ligamentous supporting tissues of the apices of the teeth resulting in a localised collection of pus.  Apical abscess is also known as endodontic or dentoalveolar abscess;
"apical cyst" means an epithelium-lined periodontal cyst involving the apex of a pulpless tooth.  Apical cyst is also known as radicular cyst;
"apical periodontitis" means a destructive inflammatory disease of the bony and ligamentous supporting tissues of the apices of the teeth.  The inflammation can be limited to the periodontal ligament, but can also involve the root cementum, dentin and alveolar bone;
"death from dental pulp and apical disease" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s dental pulp and apical disease;
"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;
"pack-years of cigarettes, or the equivalent thereof in other tobacco products" means a calculation of consumption where one pack-year of cigarettes equals twenty 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)                operational service under the VEA;
(b)                peacekeeping service under the VEA;
(c)                hazardous service under the VEA;
(d)               British nuclear test defence service under the VEA;
(e)                warlike service under the MRCA; or
(f)                 non-warlike service under the MRCA;
"terminal event" means the proximate or ultimate cause of death and includes:
(a)                pneumonia;
(b)               respiratory failure;
(c)                cardiac arrest;
(d)               circulatory failure; or
(e)                cessation of brain function;
"trauma to the region of the affected tooth" means a blunt or penetrating injury resulting in:
(a)                fracture or luxation of the affected tooth;
(b)               avulsion and subsequent replantation of the affected tooth; or
(c)                disruption or fracture of the periodontium in the region of the affected tooth.
Application
10.       This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.
Date of effect
11.       This Instrument takes effect from 15 January 2014.
Dated this   nineteenth   day of   December   2013
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed at the direction of:          )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON
 
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