Statement of Principles concerning dental pulp and periapical disease (Reasonable Hypothesis) (No. 99 of 2021) (Cth)

Statement of Principles concerning DENTAL PULP AND PERIAPICAL DISEASE (Reasonable Hypothesis) (No. 99 of 2021) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 1 October 2021

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:

Professor Terence Campbell AM Chairperson

Contents 1 Name 2 Commencement 3 Authority 4 Repeal 5 Application 6 Definitions 7 Kind of injury, disease or death to which this Statement of Principles relates 8 Basis for determining the factors 9 Factors that must exist 10 Relationship to service 11 Factors referring to an injury or disease covered by another Statement of Principles Schedule 1 - Dictionary 1 Definitions

1 Name This is the Statement of Principles concerning dental pulp and periapical disease (Reasonable Hypothesis) (No. 99 of 2021). 2 Commencement This instrument commences on 1 November 2021. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning dental pulp and apical disease No. 3 of 2014 (Federal Register of Legislation No. F2014L00014) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 pulp and periapical disease and death from dental pulp and periapical disease. Meaning of dental pulp and periapical disease (2) For the purposes of this Statement of Principles, dental pulp and periapical disease: (a) means inflammation, infection, necrosis or degeneration of the pulp of the teeth and pulp-related pathological changes involving the apices of the teeth; and (b) includes: (i) abnormal hard tissue formation in pulp, including condensing osteitis; (ii) periapical abscess; (iii) periapical cyst; (iv) periapical periodontitis; (v) pulp necrosis; (vi) pulp stones; and (vii) pulpitis; and (c) excludes: (i) peri-implantitis; and (ii) periapical lesions that are not of inflammatory origin. Note 1: Although patients may be asymptomatic, manifestations typically include mild to severe toothache, tooth pain on percussion or biting, tooth sensitivity to cold stimuli, the presence of a sinus tract and tooth discolouration. Note 2: Examples of periapical lesions that are not of inflammatory origin include developmental cysts and odontogenic tumours. Note 3: periapical abscess, periapical cyst, periapical periodontitis and pulpitis are defined in the Schedule 1 - Dictionary. (3) While dental pulp and periapical disease attracts ICD‑10‑AM code K04, in applying this Statement of Principles the meaning of dental pulp and periapical disease 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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4. Death from dental pulp and periapical disease (5) For the purposes of this Statement of Principles, dental pulp and periapical 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 periapical disease. Note: terminal event is defined in the Schedule 1 - Dictionary. 8 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that dental pulp and periapical disease and death from dental pulp and periapical 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 MRCA. Note: MRCA, relevant service and VEA are defined in the Schedule 1 - Dictionary. 9 Factors that must exist At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting dental pulp and periapical disease or death from dental pulp and periapical disease with the circumstances of a person's relevant service: (1) having dental caries involving the affected tooth before the clinical onset of dental pulp and periapical disease; (2) having periodontitis involving the periodontium supporting the affected tooth at the time of the clinical onset of dental pulp and periapical disease; (3) having trauma involving the affected tooth within the 5 years before the clinical onset of dental pulp and periapical disease; Note: trauma involving the affected tooth is defined in the Schedule 1 - Dictionary. (4) undergoing surgery involving the affected tooth within the 1 year before the clinical onset of dental pulp and periapical disease; Note: surgery is defined in the Schedule 1 - Dictionary. (5) undergoing a non-invasive dental or orthodontic procedure involving the affected tooth or the periodontium supporting the affected tooth, within the 6 months before the clinical onset of dental pulp and periapical disease; Note: non-invasive dental or orthodontic procedure is defined in the Schedule 1 - Dictionary. (6) having smoked tobacco products: (a) in an amount of at least 5 pack-years before the clinical onset of dental pulp and periapical disease; and (b) commencing at least 5 years before the clinical onset of dental pulp and periapical disease; and if smoking has ceased before the clinical onset of dental pulp and periapical disease, then that onset occurred within 10 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (7) having diabetes mellitus at the time of the clinical onset of dental pulp and periapical disease; (8) having scleroderma or Sjögren syndrome at the time of the clinical onset of dental pulp and periapical disease; (9) having osteonecrosis of the jaw involving the affected tooth at the time of the clinical onset of dental pulp and periapical disease; Note: Examples of causes of osteonecrosis of the jaw include sickle-cell disorder and medication-related osteonecrosis. (10) having dental caries involving the affected tooth before the clinical worsening of dental pulp and periapical disease; (11) having periodontitis involving the periodontium supporting the affected tooth at the time of the clinical worsening of dental pulp and periapical disease; (12) having trauma involving the affected tooth within the 5 years before the clinical worsening of dental pulp and periapical disease; Note: trauma involving the affected tooth is defined in the Schedule 1 - Dictionary. (13) undergoing surgery involving the affected tooth within the 1 year before the clinical worsening of dental pulp and periapical disease; Note: surgery is defined in the Schedule 1 - Dictionary. (14) undergoing a non-invasive dental or orthodontic procedure involving the affected tooth or the periodontium supporting the affected tooth, within the 6 months before the clinical worsening of dental pulp and periapical disease; Note: non-invasive dental or orthodontic procedure is defined in the Schedule 1 - Dictionary. (15) having smoked tobacco products: (a) in an amount of at least 5 pack-years before the clinical worsening of dental pulp and periapical disease; and (b) commencing at least 5 years before the clinical worsening of dental pulp and periapical disease; and if smoking has ceased before the clinical worsening of dental pulp and periapical disease, then that worsening occurred within 10 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (16) having diabetes mellitus at the time of the clinical worsening of dental pulp and periapical disease; (17) having scleroderma or Sjögren syndrome at the time of the clinical worsening of dental pulp and periapical disease; (18) having osteonecrosis of the jaw involving the affected tooth at the time of the clinical worsening of dental pulp and periapical disease; Note: Examples of causes of osteonecrosis of the jaw include sickle-cell disorder and medication-related osteonecrosis. (19) inability to obtain appropriate clinical management for dental pulp and periapical disease. 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 factors set out in subsections 9(10) to 9(19) apply only to material contribution to, or aggravation of, dental pulp and periapical disease where the person's dental pulp and periapical disease 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(2) 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.