Statement of Principles concerning PERIODONTAL ABSCESS (Reasonable Hypothesis) (No. 25 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986. Dated 4 March 2022 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 periodontal abscess (Reasonable Hypothesis) (No. 25 of 2022). 2 Commencement This instrument commences on 4 April 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning periodontal abscess No. 49 of 2013 (Federal Register of Legislation No. F2013L01125) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 periodontal abscess and death from periodontal abscess. Meaning of periodontal abscess (2) For the purposes of this Statement of Principles, periodontal abscess: (a) means a localised collection of pus within the periodontal tissue, adjacent to a periodontal pocket, that is associated with destruction of the bony and ligamentous tissues supporting the teeth; and (b) excludes: (i) combined periodontic-endodontic lesions; (ii) gingival abscess; (iii) periapical abscess; (iv) periapical periodontitis; and (v) pericoronal abscess. Note 1: The clinical manifestations of a periodontal abscess include gum pain, gum tenderness, tooth sensitivity and tooth mobility. An ovoid elevation in the gum along the lateral aspect of a tooth root is typical. Patients can be asymptomatic. Note 2: Extra-oral symptoms are uncommon, but can include facial swelling, fever, malaise and swelling of regional lymph nodes. Death from periodontal abscess (3) For the purposes of this Statement of Principles, periodontal abscess, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's periodontal abscess. 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 periodontal abscess and death from periodontal abscess 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 periodontal abscess or death from periodontal abscess with the circumstances of a person's relevant service: (1) having periodontitis at the affected site within the 6 months before the clinical onset of periodontal abscess; (2) having a foreign body embedded in the affected region of the periodontium at the time of the clinical onset of periodontal abscess; Note: Examples of foreign bodies that can be embedded in the periodontium include finger nails, corn husks, dental floss, shrapnel and materials derived from dental procedures such as calculus fragments, cement remnants and orthodontic separators. (3) having trauma to the affected region of the periodontium within the 4 weeks before the clinical onset of periodontal abscess; Note: trauma to the affected region of the periodontium is defined in the Schedule 1 - Dictionary. (4) having surgery to the affected region of the periodontium within the 4 weeks before the clinical onset of periodontal abscess; (5) having periodontitis at the affected site within the 6 months before the clinical worsening of periodontal abscess; (6) having a foreign body embedded in the affected region of the periodontium at the time of the clinical worsening of periodontal abscess; Note: Examples of foreign bodies that can be embedded in the periodontium include finger nails, corn husks, dental floss, shrapnel and materials derived from dental procedures such as calculus fragments, cement remnants and orthodontic separators. (7) having trauma to the affected region of the periodontium within the 4 weeks before the clinical worsening of periodontal abscess; Note: trauma to the affected region of the periodontium is defined in the Schedule 1 - Dictionary. (8) having surgery to the affected region of the periodontium within the 4 weeks before the clinical worsening of periodontal abscess; (9) inability to obtain appropriate clinical management for periodontal abscess. 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(5) to 9(9) apply only to material contribution to, or aggravation of, periodontal abscess where the person's periodontal abscess 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. Schedule 1 - Dictionary Note: See Section 6 1 Definitions In this instrument: MRCA means the Military Rehabilitation and Compensation Act 2004. periodontal abscess—see subsection 7(2). 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. Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary. 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. trauma to the affected region of the periodontium means a blunt or penetrating injury resulting in: (a) fracture, luxation, loss or extraction of a tooth; or (b) disruption or fracture of the periodontium. Note: Examples of luxation injuries include concussion, subluxation, extrusive luxation, lateral luxation and intrusive luxation of the tooth. VEA means the Veterans' Entitlements Act 1986.