Statement of Principles
concerning
 
DENTAL CARIES
No. 71 of 2007
 
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 caries No. 71 of 2007.
 
Determination
2.                  The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)       revokes Instrument No. 366 of 1995 concerning dental caries;
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 caries and death from dental caries.
(b)              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.
(c)              Dental caries attracts ICD-10-AM code K02.0, K02.1, K02.2, K02.3, K02.8 or K02.9.
(d)              In the application of this Statement of Principles, the definition of "dental caries" 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 caries and death from dental caries 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 caries or death from dental caries with the circumstances of a person’s relevant service is:
 
(a)               being a prisoner of war before the clinical onset of dental caries; or
 
(b)              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; or
 
(c)              having extreme or catastrophic hyposalivation as a result of a course of therapeutic radiation to the head or neck, for at least the 28 days before the clinical onset of dental caries; or
 
(d)              having xerostomia for a continuous period of at least 90 days, within the one year before the clinical onset of dental caries; or
 
(e)              inability to perform effective oral hygiene for a continuous period of at least 90 days, within the one year before the clinical onset of dental caries; or
 
(f)               being exposed to fermentable dietary carbohydrates for a continuous period of at least 90 days, within the one year before the clinical onset of dental caries; or
 
(g)              inability to access preventive professional dental care, including regular cleaning and application of fluoride, at least every fifteen months, within the five years before the clinical onset of dental caries; or
 
(h)              having an acquired enamel defect of the affected tooth for at least the 28 days before the clinical onset of dental caries; or
 
(i)                for root surface caries only, having gingival recession of the affected tooth for at least the 28 days before the clinical onset of dental caries; or
 
(j)                inability to obtain appropriate clinical management for dental caries.
 
Factors that apply only to material contribution or aggravation
7.         Paragraph 6(j) 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 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 course of therapeutic radiation” means one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles;
 
"acquired enamel defect" means abnormal loss of tooth substance due to trauma, abrasion or erosion;
 
"being exposed to fermentable dietary carbohydrates" 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;
 
"death from 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;
 
"exposure to fluoride" means application of fluoride to the teeth in one of the following forms:
(a)          liquid, tablet or lozenge formulation;
(b)          fluoridated drinking water in locations with low naturally-occurring fluoride concentration in the water supply; or
(c)          fluoridated toothpaste;
 
"extreme or catastrophic hyposalivation" means almost total elimination of salivary gland activity;
 
"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;
 
"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), Fifth Edition, effective date of 1 July 2006, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 772 3;
 
"oral hygiene" means the personal maintenance of cleanliness of the teeth;
 
"relevant service" means:
(a)     operational service under the VEA;
(b)     peacekeeping service under the VEA;
(c)          hazardous service under the VEA;
(d)          warlike service under the MRCA; or
(e)          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;
 
"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.
 
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 4 July 2007.
 
Dated this       twentieth     day of              June               2007
 
 
The Common Seal of the                  )
Repatriation Medical Authority       )
was affixed to this instrument          )
in the presence of:                            )
 
KEN DONALD
CHAIRPERSON