Statement of Principles concerning gingivitis No. 45 of 2013

Link to law: https://www.comlaw.gov.au/Details/F2013L01121

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now
 
Statement of Principles
concerning
 
GINGIVITIS
No. 45 of 2013
 
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 gingivitis No. 45 of 2013.
Determination
2.         The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 3 of 2002 concerning gingivitis; and
(b)        determines in its place this Statement of Principles.
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about gingivitis and death from gingivitis.
(b)               For the purposes of this Statement of Principles, "gingivitis" means an acute or chronic inflammation of the gums, limited to the mucosal epithelial tissue surrounding the cervical portion of the teeth and the alveolar processes.  This definition includes gingival abscess, peri-implant mucositis, linear gingival erythema, plasma cell gingivitis, desquamative gingivitis and acute necrotising ulcerative gingivitis.  This definition excludes oral aphthae, gingival recession, gingival hyperplasia and overgrowth, primary herpetic gingivostomatitis, and destructive gingival inflammation extending beyond the gums into the underlying supporting structures of the teeth.
(c)                Gingivitis attracts ICD-10-AM code A69.1, K05.0 or K05.1.
(d)               In the application of this Statement of Principles, the definition of "gingivitis" 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 gingivitis and death from gingivitis 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 gingivitis or death from gingivitis with the circumstances of a person’s relevant service is:
(a)                being prevented from cleaning the teeth, including toothbrushing and interdental cleansing, for a continuous period of at least seven days, within the two months before the clinical onset of gingivitis; or
(b)               having diabetes mellitus at the time of the clinical onset of gingivitis; or
(c)                having a foreign body embedded in the affected region of the gums at the time of the clinical onset of gingivitis; or
(d)               having an oral piercing adjacent to the affected region of the gums for a continuous period of at least the six months before the clinical onset of gingivitis; or
(e)                having trauma to the affected region of the gums within the four weeks before the clinical onset of gingivitis; or
(f)                being pregnant at the time of the clinical onset of gingivitis; or
(g)               being infected with human immunodeficiency virus at the time of the clinical onset of gingivitis; or
(h)               having neutropaenia, agranulocytosis or leukaemia at the time of the clinical onset of gingivitis; or
(i)                 using the combined oral contraceptive pill or a progesterone oral contraceptive pill, for a continuous period of at least the four weeks before the clinical onset of gingivitis; or
(j)                 having chronic renal disease requiring renal transplantation or dialysis at the time of the clinical onset of gingivitis; or
(k)               having an autoimmune and mucocutaneous disease from the specified list at the time of the clinical onset of gingivitis; or
(l)                 having direct exposure of the affected area to an irritant substance within the three days before the clinical onset of gingivitis; or
(m)              for acute necrotising ulcerative gingivitis only,
(i)           smoking at least two pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of gingivitis, and where smoking has ceased, the clinical onset of gingivitis has occurred within three months of cessation; or
(ii)         having a nutritional deficiency at the time of the clinical onset of gingivitis; or
(n)               experiencing a category 1A stressor or a category 1B stressor within the fourteen days before the clinical onset of gingivitis; or
(o)               having a depressive disorder at the time of the clinical onset of gingivitis; or
(p)               having drug-induced gingival hyperplasia at the time of the clinical onset of gingivitis; or
(q)               being prevented from cleaning the teeth, including toothbrushing and interdental cleansing, for a continuous period of at least seven days, within the two months before the clinical worsening of gingivitis; or
(r)                 having diabetes mellitus at the time of the clinical worsening of gingivitis; or
(s)                having a foreign body embedded in the affected region of the gums at the time of the clinical worsening of gingivitis; or
(t)                 having an oral piercing adjacent to the affected region of the gums for a continuous period of at least the six months before the clinical worsening of gingivitis; or
(u)               having trauma to the affected region of the gums within the four weeks before the clinical worsening of gingivitis; or
(v)               being pregnant at the time of the clinical worsening of gingivitis; or
(w)             being infected with human immunodeficiency virus at the time of the clinical worsening of gingivitis; or
(x)               having neutropaenia, agranulocytosis or leukaemia at the time of the clinical worsening of gingivitis; or
(y)               using the combined oral contraceptive pill or a progesterone oral contraceptive pill, for a continuous period of at least the four weeks before the clinical worsening of gingivitis; or
(z)                having chronic renal disease requiring renal transplantation or dialysis at the time of the clinical worsening of gingivitis; or
(aa)            having an autoimmune and mucocutaneous disease from the specified list at the time of the clinical worsening of gingivitis; or
(bb)           having direct exposure of the affected area to an irritant substance within the three days before the clinical worsening of gingivitis; or
(cc)             for acute necrotising ulcerative gingivitis only,
(i)           smoking at least two pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of gingivitis, and where smoking has ceased, the clinical worsening of gingivitis has occurred within three months of cessation; or
(ii)         having a nutritional deficiency at the time of the clinical worsening of gingivitis; or
(dd)          experiencing a category 1A stressor or a category 1B stressor within the fourteen days before the clinical worsening of gingivitis; or
(ee)            having a depressive disorder at the time of the clinical worsening of gingivitis; or
(ff)             having drug-induced gingival hyperplasia at the time of the clinical worsening of gingivitis; or
(gg)           inability to obtain appropriate clinical management for gingivitis.
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(q) to 6(gg) apply only to material contribution to, or aggravation of, gingivitis where the person’s gingivitis 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 category 1A stressor" means one or more of the following severe traumatic events:
(a)                experiencing a life-threatening event;
(b)               being subject to a serious physical attack or assault including rape and sexual molestation; or
(c)                being threatened with a weapon, being held captive, being kidnapped, or being tortured;
"a category 1B stressor" means one of the following severe traumatic events:
(a)                being an eyewitness to a person being killed or critically injured;
(b)               viewing corpses or critically injured casualties as an eyewitness;
(c)                being an eyewitness to atrocities inflicted on another person or persons;
(d)               killing or maiming a person; or
(e)                being an eyewitness to or participating in, the clearance of critically injured casualties;
"a foreign body" means:
(a)                a fixed orthodontic appliance;
(b)               an osseointegrated implant or dental prosthesis, including single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses or posts and cores;
(c)                microscopic materials derived from dental procedures; or
(d)               shrapnel or other exogenous macroscopic material;
"a nutritional deficiency" means:
(a)                scurvy; or
(b)               clinical or biochemical evidence of a severe protein energy malnutrition due to:
(i)            inadequate intake of protein or energy; or
(ii)          systemic disease that impairs intake or utilisation of nutrients or that increases nutrient requirements or metabolic losses;
"an autoimmune and mucocutaneous disease from the specified list" means:
(a)                bullous pemphigoid;
(b)               chronic ulcerative stomatitis;
(c)                dermatomyositis;
(d)               epidermolysis bullosa acquisita;
(e)                erythema multiforme;
(f)                graft versus host disease;
(g)               linear IgA disease;
(h)               mixed connective tissue disease;
(i)                 mucous membrane pemphigoid;
(j)                 oral lichen planus;
(k)               oral lichenoid lesions;
(l)                 pemphigus vulgaris;
(m)             psoriasis;
(n)               Sjogren's syndrome; or
(o)               systemic lupus erythematosus;
"an eyewitness" means a person who observes an incident first hand and can give direct evidence of it.  This excludes a person exposed only to media coverage of the incident;
"an irritant substance" means a chemical agent which causes an inflammatory effect on living tissue at the site of contact.  This includes reactions attributable to toothpaste or dentrifices, mouthwashes, chewing gum additives or foods, or dental restoration materials;
"an oral piercing" means permanent insertion of an ornament into an opening made in the skin or mucosa of the tongue, lips or cheek;
"acute necrotising ulcerative gingivitis" means a painful and rapidly progressive inflammation of the gums characterised by gingival bleeding with interdental soft tissue necrosis and ulceration, and is also known as Vincent’s disease and trenchmouth;
"combined oral contraceptive pill" means an oral contraceptive compound containing both oestrogen and progestogen;
"death from gingivitis" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s gingivitis;
"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 20 tailor-made cigarettes per day for a period of one calendar year, or 7300 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 means either 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 affected region of the gums" means physical injury to the gingival tissues by mechanisms including thermal, electrical and chemical burns, abrasion, and blunt or penetrating trauma.
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 3 July 2013.
Dated this   twenty-first   day of   June   2013
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed to this instrument                        )
in the presence of:                               )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON