Statement of Principles concerning tooth wear (Balance of Probabilities) (No. 53 of 2017)

Statement of Principles concerning tooth wear (Balance of Probabilities) (No. 53 of 2017)

made under subsection 196B(3) of the

Veterans' Entitlements Act 1986

Compilation No. 1  

Compilation date:   24 September 2018

Includes amendments up to: Amendment Statement of Principles concerning tooth wear (Balance of Probabilities) (No. 86 of 2018) (F2018L01170)

The day of commencement of this Amendment Statement of Principles concerning tooth wear is 24 September 2018.

About this compilation

This compilation

This is a compilation of the Statement of Principles concerning tooth wear (Balance of Probabilities) (No. 53 of 2017) that shows the text of the law as amended and in force on 24 September 2018.

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Statement of Principles

concerning

TOOTH WEAR
(Balance of Probabilities)

(No. 53 of 2017)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 18 August 2017

Contents

1 Name

2 Commencement

3 Authority

4 Application

5 Definitions

6 Kind of injury, disease or death to which this Statement of Principles relates

7 Basis for determining the factors

8 Factors that must exist

9 Relationship to service

10 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 tooth wear (Balance of Probabilities) (No. 53 of 2017).

2               Commencement

This instrument commences on 18 September 2017.

3               Authority

This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.

4               Application

This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.

5               Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

6               Kind of injury, disease or death to which this Statement of Principles relates

(1)          This Statement of Principles is about tooth wear and death from tooth wear.

Meaning of tooth wear

(2)          For the purposes of this Statement of Principles, tooth wear means:

(a)          the localised or generalised loss of dental hard tissues (enamel, dentine and dental restorative material) due to an intrinsic or extrinsic mechanical or chemical process; and

(b)          where dentine is exposed on at least one tooth surface, and causes:

(i)            severe tooth pain or sensitivity; or

(ii)         significant impairment of effective tooth function; and

(c)          is confirmed by a dental clinician using a recognised tooth wear evaluation system; and

(d)          comprises:

(i)            dental abrasion;

(ii)         dental attrition; and

(iii)       dental erosion; and

(e)           excludes:

(i)            mild tooth wear which is confined to the enamel; and

(ii)         loss of tooth substance caused by dental caries or discrete dental trauma.

Note 1:  Tooth wear may cause tooth pain or dentine hypersensitivity that is persistent, or which occurs with eating, drinking or tooth cleaning, and which is of sufficient severity to interfere with normal oral function or require dental consultation.  Masticatory function can be compromised by tooth pain and reduced vertical and horizontal dimension of the affected dentition. 

Note 2:  Dental reconstruction may be required.

Note 3:  dental abrasion, dental attrition and dental erosion are defined in the Schedule 1 - Dictionary.

(3)          While tooth wear attracts ICD‑10‑AM code K03.0, K03.1 or K03.2, in applying this Statement of Principles the meaning of tooth wear 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), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.

Death from tooth wear

(5)          For the purposes of this Statement of Principles, tooth wear, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's tooth wear.

Note: terminal event is defined in the Schedule 1 – Dictionary.

7               Basis for determining the factors

On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that tooth wear and death from tooth wear can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.

Note: relevant service is defined in the Schedule 1 – Dictionary.

8               Factors that must exist

At least one of the following factors must exist before it can be said that, on the balance of probabilities, tooth wear or death from tooth wear is connected with the circumstances of a person's relevant service:

(1)          for dental attrition only, having bruxism at the time of the clinical onset of tooth wear;

Note:  dental attrition is defined in the Schedule 1 - Dictionary.

(2)          for dental erosion only:

(a)          consuming an average of at least 1.5 litres per day of any combination of drinks from the specified list of erosive drinks:

(i)            for a continuous period of at least five years before the clinical onset of tooth wear; and

(ii)         where that exposure has ceased, the clinical onset of tooth wear has occurred within one year of cessation;

Note: dental erosion and specified list of erosive drinks are defined in the Schedule 1 - Dictionary.             

(b)          having symptomatic gastro-oesophageal reflux disease within the two years before the clinical onset of tooth wear;

(c)          having an eating disorder at the time of the clinical onset of tooth wear;

(d)          having alcohol use disorder at the time of the clinical onset of tooth wear;

(e)          having xerostomia for at least the one year before the clinical onset of tooth wear;

Note: xerostomia is defined in the Schedule 1 - Dictionary. 

(f)           having hyperemesis gravidarum within the three months before the clinical onset of tooth wear;

Note: hyperemesis gravidarum is defined in the Schedule 1 - Dictionary.

(g)          swimming in a swimming pool with a pH below 5.5 for a cumulative period of at least 50 hours within the 30 days before the clinical onset of tooth wear;

(h)          taking a drug from the specified list of drugs, on average at least daily, for a continuous period of at least the one year before the clinical onset of tooth wear, and where:

(i)            a dissolved solution of the drug is swilled around the teeth; or

(ii)         the drug is retained in the mouth adjacent to the affected site; or

Note: specified list of drugs is defined in the Schedule 1 - Dictionary. 

(i)            breathing fumes of a substance from the specified list of acidic substances at a concentration of greater than 0.5 milligrams per cubic metre:

(i)            for a cumulative period of at least 2 000 hours before the clinical onset of tooth wear; and

(ii)         where that exposure has ceased, the clinical onset of tooth wear has occurred within six months of cessation;

Note: fumes and specified list of acidic substances are defined in the Schedule 1 - Dictionary.

(j)            vomiting or regurgitating gastric contents on at least 100 occasions within the one year before the clinical onset of tooth wear;

(3)          for dental attrition only, having bruxism at the time of the clinical worsening of tooth wear;

Note:  dental attrition is defined in the Schedule 1 - Dictionary.

(4)          for dental erosion only:

(a)          consuming an average of at least 1.5 litres per day of any combination of drinks from the specified list of erosive drinks:

(i)            for a continuous period of at least five years before the clinical worsening of tooth wear; and

(ii)         where that exposure has ceased, the clinical worsening of tooth wear has occurred within one year of cessation;

Note: dental erosion and specified list of erosive drinks are defined in the Schedule1 - Dictionary.             

(b)          having symptomatic gastro-oesophageal reflux disease within the two years before the clinical worsening of tooth wear;

(c)          having an eating disorder at the time of the clinical worsening of tooth wear;

(d)          having alcohol use disorder at the time of the clinical worsening of tooth wear;

(e)          having xerostomia for at least the one year before the clinical worsening of tooth wear;

Note: xerostomia is defined in the Schedule 1 - Dictionary. 

(f)           having hyperemesis gravidarum within the three months before the clinical worsening of tooth wear;

Note: hyperemesis gravidarum is defined in the Schedule 1 - Dictionary.

(g)          swimming in a swimming pool with a pH below 5.5 for a cumulative period of at least 50 hours within the 30 days before the clinical worsening of tooth wear;

(h)          taking a drug from the specified list of drugs, on average at least daily, for a continuous period of at least the one year before the clinical worsening of tooth wear, and where:

(i)            a dissolved solution of the drug is swilled around the teeth; or

(ii)         the drug is retained in the mouth adjacent to the affected site; or

Note: specified list of drugs is defined in the Schedule 1 - Dictionary. 

(i)            breathing fumes of a substance from the specified list of acidic substances at a concentration of greater than 0.5 milligrams per cubic metre:

(i)            for a cumulative period of at least 2 000 hours before the clinical worsening of tooth wear; and

(ii)         where that exposure has ceased, the clinical worsening of tooth wear has occurred within six months of cessation;

Note: fumes and specified list of acidic substances are defined in the Schedule 1 - Dictionary.

(j)            vomiting or regurgitating gastric contents on at least 100 occasions within the one year before the clinical worsening of tooth wear;

(5)          inability to obtain appropriate clinical management for tooth wear.

9               Relationship to service

(1)          The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.

(2)          The factors set out in subsections 8(3) to 8(5) apply only to material contribution to, or aggravation of, tooth wear where the person's tooth wear was suffered or contracted before or during (but did not arise out of) the person's relevant service.

10           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 8 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(3) 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 5

1               Definitions

In this instrument:

                               dental abrasion means the loss of tooth substance through friction of exogenous material that is forced over the surfaces of the tooth, independent of occlusal contact.

                               dental attrition means the loss of hard tooth substance from occlusal contact between an opposing tooth or teeth, or dental restoration or dental restorations.

                               dental erosion means corrosion of tooth structure by a nonbacterial chemical, biochemical or electrochemical process.

                               fumes means aerosols or vapours arising through industrial processes or from workplace practices that involve the refining, manufacture or use of the stated substance.

                               hyperemesis gravidarum means a complication of pregnancy that is characterised by severe nausea and vomiting, with weight loss and dehydration.

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                             relevant service means:

(a)          eligible war service (other than operational service) under the VEA;

(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

(c)          peacetime service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary. 

                               specified list of acidic substances means:

(a)          hydrochloric acid;

(b)          hydrofluoric acid;

(c)          nitric acid;

(d)          phosphoric acid; or

(e)          sulphuric acid.

                               specified list of drugs means:

(a)          aspirin powder;

(b)          chewable aspirin tablets;

(c)          chewable hydrochloric acid tablets; or

(d)          chewable Vitamin C tablets.

                               specified list of erosive drinks means:

(a)          alcopops or alcoholic cooler drinks;

(b)          any beverage with a pH value below 4.0;

(c)          carbonated soft drinks;

(d)          flavoured mineral water;

(e)          herbal and fruit tea (without milk);

(f)           natural or processed citrus, apple or other acidic fruit juices;

(g)          non-calcium-enriched sports drinks; or

(h)          wine.

                             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.

                             tooth wear—see subsection 6(2).

                             VEA means the Veterans' Entitlements Act 1986.

                             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.

Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history. 

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history