{"id":"F2021L01389","name":"Statement of Principles concerning dental pulp and periapical disease (Balance of Probabilities) (No. 100 of 2021)","slug":"statement-of-principles-concerning-dental-pulp-and-periapical-disease-balance-of-probabilities-no-10","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441028,"registerId":"F2021L01389-fast-fetch-1775956460081","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning dental pulp and periapical disease (Balance of Probabilities) (No. 100 of 2021)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nDENTAL PULP AND PERIAPICAL DISEASE (Balance of Probabilities)\n\n(No. 100 of 2021)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 1 October 2021\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n|
Professor Terence Campbell AM
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning dental pulp and periapical disease (Balance of Probabilities) (No. 100 of 2021).\n\n2 Commencement\n\n This instrument commences on 1 November 2021.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning dental pulp and apical disease No. 4 of 2014 (Federal Register of Legislation No. F2014L00009) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about dental pulp and periapical disease and death from dental pulp and periapical disease.\n\nMeaning of dental pulp and periapical disease\n\n(2) For the purposes of this Statement of Principles, dental pulp and periapical disease:\n\n(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\n\n(b) includes:\n\n(i) abnormal hard tissue formation in pulp, including condensing osteitis;\n\n(ii) periapical abscess;\n\n(iii) periapical cyst;\n\n(iv) periapical periodontitis;\n\n(v) pulp necrosis;\n\n(vi) pulp stones; and\n\n(vii) pulpitis; and\n\n(c) excludes:\n\n(i) peri-implantitis; and\n\n(ii) periapical lesions that are not of inflammatory origin.\n\nNote 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.\n\nNote 2: Examples of periapical lesions that are not of inflammatory origin include developmental cysts and odontogenic tumours.\n\nNote 3: periapical abscess, periapical cyst, periapical periodontitis and pulpitis are defined in the Schedule 1 - Dictionary.\n\n(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).\n\n(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.\n\nDeath from dental pulp and periapical disease\n\n(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.\n\nNote: terminal event is defined in the Schedule 1 - Dictionary.\n\n8 Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that dental pulp and periapical disease and death from dental pulp and periapical disease can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 - Dictionary.\n\n9 Factors that must exist\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, dental pulp and periapical disease or death from dental pulp and periapical disease is connected with the circumstances of a person's relevant service:\n\n(1) having dental caries involving the affected tooth before the clinical onset of dental pulp and periapical disease;\n\n(2) having periodontitis involving the periodontium supporting the affected tooth at the time of the clinical onset of dental pulp and periapical disease;\n\n(3) having trauma involving the affected tooth within the 5 years before the clinical onset of dental pulp and periapical disease;\n\nNote: trauma involving the affected tooth is defined in the Schedule 1 - Dictionary.\n\n(4) undergoing surgery involving the affected tooth within the 1 year before the clinical onset of dental pulp and periapical disease;\n\nNote: surgery is defined in the Schedule 1 - Dictionary.\n\n(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;\n\nNote: non-invasive dental or orthodontic procedure is defined in the Schedule 1 - Dictionary.\n\n(6) having smoked tobacco products:\n\n(a) in an amount of at least 5 pack-years before the clinical onset of dental pulp and periapical disease; and\n\n(b) commencing at least 5 years before the clinical onset of dental pulp and periapical disease; and\n\nif smoking has ceased before the clinical onset of dental pulp and periapical disease, then that onset occurred within 10 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(7) having dental caries involving the affected tooth before the clinical worsening of dental pulp and periapical disease;\n\n(8) having periodontitis involving the periodontium supporting the affected tooth at the time of the clinical worsening of dental pulp and periapical disease;\n\n(9) having trauma involving the affected tooth within the 5 years before the clinical worsening of dental pulp and periapical disease;\n\nNote: trauma involving the affected tooth is defined in the Schedule 1 - Dictionary.\n\n(10) undergoing surgery involving the affected tooth within the 1 year before the clinical worsening of dental pulp and periapical disease;\n\nNote: surgery is defined in the Schedule 1 - Dictionary.\n\n(11) 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;\n\nNote: non-invasive dental or orthodontic procedure is defined in the Schedule 1 - Dictionary.\n\n(12) having smoked tobacco products:\n\n(a) in an amount of at least 5 pack-years before the clinical worsening of dental pulp and periapical disease; and\n\n(b) commencing at least 5 years before the clinical worsening of dental pulp and periapical disease; and\n\nif smoking has ceased before the clinical worsening of dental pulp and periapical disease, then that worsening occurred within 10 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(13) inability to obtain appropriate clinical management for dental pulp and periapical disease.\n\n10 Relationship to service\n\n(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.\n\n(2) The factors set out in subsections 9(7) to 9(13) 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.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(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;\n\nthen 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.\n\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n dental concussion means an injury of the tooth-supporting structures without increased mobility or displacement of the tooth but with pain on percussion.\n\n dental pulp and periapical disease—see subsection 7(2).\n\n luxation means an injury of the tooth-supporting structures with increased mobility or displacement of the tooth.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n non-invasive dental or orthodontic procedure means the therapeutic application of a chemical substance, heat or cold, or a physical force to the surface of the teeth, during the course of dental or orthodontic treatment;\n\nNote: Examples of a non-invasive dental or orthodontic procedure include:\n\n(i) acid etching;\n\n(ii) dehydration;\n\n(iii) in-office tooth bleaching;\n\n(iv) orthodontic treatment;\n\n(v) restorative procedures such as cavity preparation, crown preparation and curing of resins during provisional restorations; and\n\n(vi) vibration or mechanical irritation.\n\n 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.\n\nNote 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.\n\nNote 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.\n\n periapical abscess means a destructive process in the bony and ligamentous supporting tissues of the apices of the teeth resulting in a localised collection of pus. It can be acute or chronic, and may be symptomatic or asymptomatic. Periapical abscess is also known as endodontic or dentoalveolar abscess.\n\n periapical cyst means an epithelium-lined periodontal cyst involving the apex of a devitalised tooth. Periapical cyst is also known as radicular or odontogenic cyst.\n\n periapical periodontitis means an acute or chronic destructive inflammatory disease of the bony and ligamentous supporting tissues of the apices of the teeth. The inflammation can be limited to the periodontal ligament, but can also involve the root cementum, dentin and alveolar bone. Periapical periodontitis is also known as apical periodontitis.\n\n pulpitis means acute or chronic, reversible or irreversible inflammation of the dental pulp.\n\n relevant service means:\n\n(a) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n surgery means dental surgery, orthodontic surgery or maxillofacial surgery.\n\n terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\n trauma involving the affected tooth means a blunt or penetrating injury resulting in:\n\n(a) avulsion and subsequent replantation of the affected tooth;\n\n(b) dental concussion;\n\n(c) disruption or fracture of the periodontium in the region of the affected tooth;\n\n(d) fracture or crack of the affected tooth; or\n\n(e) luxation of the affected tooth.\n\nNote: dental concussion and luxation are also defined in the Schedule 1 - Dictionary.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument continues the core purpose of linking dental pulp and periapical disease to relevant service for entitlement decisions (see s.7 and s.8). It repeals the earlier 2014 Statement (s.4) and restates definitions, qualifying factors, timing rules and cross‑references to other Statements (s.9–s.11, Schedule 1), but does not alter that underlying scope of relating the named dental conditions to service for claims."},"complexity_factors":["Technical medical definitions and exclusions (definitions and scope of dental pulp and periapical disease; Schedule 1; s.7(2)–(4)): requires clinical interpretation.","Multiple, distinct temporal thresholds for qualifying factors (trauma within 5 years; surgery within 1 year; non‑invasive procedures within 6 months; smoking initiation and cessation windows; s.9(3)–(6), s.9(9)–(12)).","Quantified tobacco exposure and calculation method (one pack‑year and pack‑year calculation; Schedule 1, notes and s.9(6),(12)): needs documented smoking history.","Distinction between causation, material contribution and aggravation (s.10(2)): different tests apply depending on whether condition arose during service or pre‑existed.","Cross‑references to other Statements of Principles where comorbid injuries/diseases are involved (s.11): introduces dependency on other instruments and their current terms.","Inclusion of death via terminal event where dental disease contributed (s.7(5) and Schedule 1 terminal event): extends determinations to proximate causes of death.","Legal evidentiary standard and administrative application (balance of probabilities; s.8 and instrument title), combined with requirement that listed factors be related to relevant service (s.10(1)): applies legal and medical judgment.","Repeal and replacement mechanics (repeals 2014 Statement; s.4) and application to specified claim schemes (VEA and MRCA; s.3,s.5): administrative transition issues for claim processing."],"plain_english_summary":"This Statement of Principles sets out when dental pulp and periapical disease (and death from it) can be accepted as connected to a person’s relevant military service for veterans’ entitlement claims. It defines the dental conditions, lists specific qualifying medical and service-related factors (for example: prior caries or periodontitis, recent trauma or dental surgery, certain dental procedures, defined smoking exposure, or inability to obtain care) and fixes timing and evidentiary rules used to decide claims."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles under the veterans' compensation scheme. It maintains the same scope as its 2014 predecessor and other similar instruments — establishing causal factors for a specific medical condition. The update reflects current medical terminology (changing 'apical' to 'periapical' in the title) and revised evidentiary standards, but does not expand beyond the original purpose of determining service connection for dental diseases."},"complexity_factors":["13 distinct causal factors with varying time limits (6 months, 1 year, 5 years, 10 years) and cumulative conditions (smoking factors require pack-years calculation plus commencement timing plus cessation windows)","Dual structure covering both clinical onset (factors 1-6) and clinical worsening (factors 7-12), with factor 13 applying to both","Cross-referencing mechanism in section 11 allowing incorporation of other Statements of Principles by reference","17 defined terms in Schedule 1, including nested definitions (e.g., 'trauma involving the affected tooth' refers to 'dental concussion' and 'luxation', which are separately defined)","Specific exclusion clauses in the disease definition (peri-implantitis and non-inflammatory lesions excluded)","Conditional logic in smoking factors requiring three cumulative elements: quantity threshold, commencement timing, and cessation proximity test"],"plain_english_summary":"This instrument sets the medical test the Repatriation Medical Authority uses to decide if dental pulp and periapical disease is service-related for veterans and current/former defence members, requiring proof on the balance of probabilities and specifying 13 medical factors that can link the condition to service. \n\nIt determines entitlement to compensation for tooth infections and related bone disease (excluding implants and non‑inflammatory growths) and replaces the 2014 criteria, so meeting a listed factor is often decisive for claims."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-dental-pulp-and-periapical-disease-balance-of-probabilities-no-10","history":"/api/acts/statement-of-principles-concerning-dental-pulp-and-periapical-disease-balance-of-probabilities-no-10/history","analysis":"/api/acts/statement-of-principles-concerning-dental-pulp-and-periapical-disease-balance-of-probabilities-no-10/analysis","conflicts":"/api/acts/statement-of-principles-concerning-dental-pulp-and-periapical-disease-balance-of-probabilities-no-10/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-dental-pulp-and-periapical-disease-balance-of-probabilities-no-10/important-cases","documents":"/api/acts/statement-of-principles-concerning-dental-pulp-and-periapical-disease-balance-of-probabilities-no-10/documents"}}