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No. 18 of 2022 Determinations/Veterans' Entitlements as made
This instrument is the Statement of Principles determined by the Repatriation Medical Authority concerning gingivitis (Balance of Probabilities).
Administered by: Veterans' Affairs
Registered 04 Jan 2022
Table of contents.

Title: RMA Australian Government Coat of Arms - Description: RMA Australian Government Coat of Arms

 

Statement of Principles

concerning

GINGIVITIS
 (Balance of Probabilities)

(No. 18 of 2022)

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

 

Dated    24 December 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........................................................................................................................................... 3

2          Commencement........................................................................................................................ 3

3          Authority..................................................................................................................................... 3

4          Repeal......................................................................................................................................... 3

5          Application................................................................................................................................. 3

6          Definitions.................................................................................................................................. 3

7          Kind of injury, disease or death to which this Statement of Principles relates............... 3

8          Basis for determining the factors........................................................................................... 4

9          Factors that must exist............................................................................................................. 4

10        Relationship to service............................................................................................................. 8

11        Factors referring to an injury or disease covered by another Statement of Principles. 8

Schedule 1 - Dictionary............................................................................................. 9

1          Definitions.................................................................................................................................. 9

 

 


 

1               Name

This is the Statement of Principles concerning gingivitis (Balance of Probabilities) (No. 18 of 2022).

2               Commencement

This instrument commences on 31 January 2022.

3               Authority

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

4               Repeal

The Statement of Principles concerning gingivitis No. 46 of 2013 (Federal Register of Legislation No. F2013L01124) made under subsections 196B(3) and (8) of the VEA is repealed.

5               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.

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 gingivitis and death from gingivitis.

Meaning of gingivitis

(2)          For the purposes of this Statement of Principles, gingivitis:

(a)          means an acute or chronic inflammation of the gums, limited to the mucosal epithelial tissue overlying the alveolar ridge and surrounding the necks of erupted teeth; and

(b)          includes:

(i)            acute necrotising ulcerative gingivitis;

(ii)          desquamative gingivitis;

(iii)        gingival abscess;

(iv)        linear gingival erythema;

(v)          peri-implant mucositis; and

(vi)        plasma cell gingivitis; and

(c)          excludes:

(i)            destructive gingival inflammation extending beyond the gums into the underlying supporting structures of the teeth;

(ii)          gingival hyperplasia and overgrowth;

(iii)        gingival recession; and

(iv)        oral aphthae.

(3)          While gingivitis attracts ICD‑10‑AM code A69.1, K05.0 or K05.1, in applying this Statement of Principles the meaning of gingivitis 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 gingivitis

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

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

8               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 gingivitis and death from gingivitis can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, gingivitis or death from gingivitis is connected with the circumstances of a person's relevant service:

(1)          being prevented from cleaning the teeth, including toothbrushing and interdental cleansing, for a continuous period of at least 14 days, within the 30 days before the clinical onset of gingivitis;

(2)          having a foreign body embedded in the affected region of the gums at the time of the clinical onset of gingivitis;

Note: Examples of a foreign body embedded in the gums include a fixed orthodontic appliance, an osseointegrated implant or dental prosthesis, particulate materials derived from dental procedures and shrapnel.

(3)          having trauma to the affected region of the gums within the 2 weeks before the clinical onset of gingivitis;

Note: trauma to the affected region of the gums is defined in the Schedule 1 - Dictionary.

(4)          having direct exposure of the affected area to an irritant substance within the 3 days before the clinical onset of gingivitis;

Note: irritant substance is defined in the Schedule 1 - Dictionary.

(5)          having direct exposure of the affected area to an allergen within the 3 days before the clinical onset of gingivitis;

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

(6)          having infection with human immunodeficiency virus at the time of the clinical onset of gingivitis;

(7)          having chronic renal failure at the time of the clinical onset of gingivitis;

Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

(8)          having leukaemia or lymphoma at the time of the clinical onset of gingivitis;

(9)          taking a drug that causes neutropenia or agranulocytosis, at the time of the clinical onset of gingivitis;

Note: Examples of drugs that cause neutropenia or agranulocytosis include clozapine, sulfasalazine, ticlopidine and thioamides such as methimazole, carbimazole and propylthiouracil.

(10)      having severe vitamin C deficiency at the time the of clinical onset of gingivitis;

Note: severe vitamin C deficiency is defined in the Schedule 1 - Dictionary.

(11)      having stem cell transplant or bone marrow transplant before the clinical onset of gingivitis;

(12)      being pregnant at the time of the clinical onset of gingivitis;

(13)      using the combined oral contraceptive pill as specified for a continuous period of at least the 4 weeks before the clinical onset of gingivitis;

Note: combined oral contraceptive pill as specified is defined in the Schedule 1 - Dictionary.

(14)      having an autoimmune or mucocutaneous disease from the specified list of autoimmune or mucocutaneous diseases at the time of the clinical onset of gingivitis;

Note: specified list of autoimmune or mucocutaneous diseases is defined in the Schedule 1 - Dictionary.

(15)      having diabetes mellitus at the time of the clinical onset of gingivitis;

(16)      having infection involving the affected region of the gums at the time of the clinical onset of gingivitis;

Note: Examples of infections that may involve the gums include tuberculosis, gonorrhoea, syphilis, chickenpox, candidiasis, histoplasmosis, herpes simplex and hand, foot and mouth disease.

(17)      for acute necrotising ulcerative gingivitis only:

(a)          having severe malnutrition at the time of the clinical onset of acute necrotising ulcerative gingivitis; or

(b)          having smoked tobacco products:

(i)            in an amount of at least 5 pack-years before the clinical onset of acute necrotising ulcerative gingivitis; and

(ii)          if smoking has ceased before the clinical onset of acute necrotising ulcerative gingivitis, then that onset occurred within 1 month of cessation;

Note: acute necrotising ulcerative gingivitis and one pack-year are defined in the Schedule 1 - Dictionary.

(18)      being prevented from cleaning the teeth, including toothbrushing and interdental cleansing, for a continuous period of at least 14 days, within the 30 days before the clinical worsening of gingivitis;

(19)      having a foreign body embedded in the affected region of the gums at the time of the clinical worsening of gingivitis;

Note: Examples of a foreign body embedded in the gums include a fixed orthodontic appliance, an osseointegrated implant or dental prosthesis, particulate materials derived from dental procedures and shrapnel.

(20)      having trauma to the affected region of the gums within the 2 weeks before the clinical worsening of gingivitis;

Note: trauma to the affected region of the gums is defined in the Schedule 1 - Dictionary.

(21)      having direct exposure of the affected area to an irritant substance within the 3 days before the clinical worsening of gingivitis;

Note: irritant substance is defined in the Schedule 1 - Dictionary.

(22)      having direct exposure of the affected area to an allergen within the 3 days before the clinical worsening of gingivitis;

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

(23)      having infection with human immunodeficiency virus at the time of the clinical worsening of gingivitis;

(24)      having chronic renal failure at the time of the clinical worsening of gingivitis;

Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

(25)      having leukaemia or lymphoma at the time of the clinical worsening of gingivitis;

(26)      taking a drug that causes neutropenia or agranulocytosis, at the time of the clinical worsening of gingivitis;

Note: Examples of drugs that cause neutropenia or agranulocytosis include clozapine, sulfasalazine, ticlopidine and thioamides such as methimazole, carbimazole and propylthiouracil.

(27)      having severe vitamin C deficiency at the time of the clinical worsening of gingivitis;

Note: severe vitamin C deficiency is defined in the Schedule 1 - Dictionary.

(28)      having stem cell transplant or bone marrow transplant before the clinical worsening of gingivitis;

(29)      being pregnant at the time of the clinical worsening of gingivitis;

(30)      using the combined oral contraceptive pill as specified for a continuous period of at least the 4 weeks before the clinical worsening of gingivitis;

Note: combined oral contraceptive pill as specified is defined in the Schedule 1 - Dictionary.

(31)      having an autoimmune or mucocutaneous disease from the specified list of autoimmune or mucocutaneous diseases at the time of the clinical worsening of gingivitis;

Note: specified list of autoimmune or mucocutaneous diseases is defined in the Schedule 1 - Dictionary.

(32)      having diabetes mellitus at the time of the clinical worsening of gingivitis;

(33)      having infection involving the affected region of the gums at the time of the clinical worsening of gingivitis;

Note: Examples of infections that may involve the gums include tuberculosis, gonorrhoea, syphilis, chickenpox, candidiasis, histoplasmosis, herpes simplex and hand, foot and mouth disease.

(34)      for acute necrotising ulcerative gingivitis only:

(a)          having severe malnutrition at the time of the clinical worsening of acute necrotising ulcerative gingivitis; or

(b)          having smoked tobacco products:

(i)            in an amount of at least 5 pack-years before the clinical worsening of acute necrotising ulcerative gingivitis; and

(ii)          if smoking has ceased before the clinical worsening of acute necrotising ulcerative gingivitis, then that worsening occurred within 1 month of cessation;

Note: acute necrotising ulcerative gingivitis and one pack-year are defined in the Schedule 1 - Dictionary.

(35)      inability to obtain appropriate clinical management for gingivitis.

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(18) to 9(35) apply only to material contribution to, or aggravation of, gingivitis where the person's gingivitis 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(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 6

1               Definitions

 In this instrument:

                               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.

Note: Acute necrotising ulcerative gingivitis is also known as Vincent gingivitis and trench mouth.

                               allergen means an antigenic substance capable of producing an immune response.

                               chronic renal failure means:

(a)           having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or

(b)          a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or

(c)           undergoing chronic dialysis.

                               combined oral contraceptive pill as specified means an oral contraceptive pill containing estrogen at a minimum dose of 50 milligrams and a progestogen at a minimum dose of 1 milligram.

                               gingivitis—see subsection 7(2).

                               irritant substance means a chemical which causes an inflammatory effect on living tissue by chemical action at the site of contact.

Note: Examples of irritant substances include tooth whitening products, dentrifices and mouthwashes.

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                               one pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.

Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.

Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.

                             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.

                               severe vitamin C deficiency means symptoms of scurvy or a serum ascorbic acid level of less than 2.5 milligrams per litre.

                               specified list of autoimmune or mucocutaneous diseases means:

(a)           bullous pemphigoid;

(b)          chronic ulcerative stomatitis;

(c)           dermatomyositis;

(d)          discoid lupus erythematosus;

(e)           epidermolysis bullosa acquisita;

(f)           erythema multiforme;

(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)          Sjögren syndrome; or

(o)          systemic lupus erythematosus.

                             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 gums means physical injury to the gingival tissues by various mechanisms including thermal, electrical and chemical burns, abrasion, and blunt or penetrating trauma.

Note: Examples of trauma to the gums include tooth fractures, inappropriate teeth cleaning (including toothbrushing or dental flossing), damage to the gums with sharp instruments and thermal burns from the consumption of hot foods or beverages.

                             VEA means the Veterans' Entitlements Act 1986.