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Statement of Principles

Periodontitis — DVA SoP factors

Every factor in the Repatriation Medical Authority Statements of Principles for Periodontitis. DVA can only accept a claim for Periodontitis if at least one of these factors is met and connected to your service. Reasonable Hypothesis (RH) applies to operational service; Balance of Probabilities (BoP) applies to peacetime service.

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Source: Repatriation Medical Authority Statements of Principles as held by the Veterans Health Centre. SoPs are amended and replaced regularly; always confirm the current instrument at rma.gov.au before relying on it.

Periodontitis

RH No. 27 of 2022 · BoP No. 28 of 202268 factors

Meaning of periodontitis: For the purposes of this Statement of Principles, periodontitis: (a) means inflammation of the tissues that support the teeth, with periodontal pocketing and destruction of the periodontal ligament or alveolar bone, leading to progressive attachment loss and tooth loss at diseased sites; and (b) includes: (i) aggressive periodontitis; (ii) chronic periodontitis; (iii) necrotising ulcerative periodontitis; (iv) peri-implantitis; and (v) periodontitis as a manifestation of acquired systemic disease; and (c) excludes: (i) abscess of the periodontium; (ii) acute necrotising ulcerative gingivitis; (iii) chronic apical periodontitis; (iv) maxillary and mandibular osteonecrosis; (v) other combined periodontic-endodontic lesions; and (vi) pericoronitis. (3) While periodontitis attracts ICD-10-AM code K05.3, in applying this Statement of Principles the meaning of periodontitis 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 Edi

Reasonable Hypothesis (RH) — Statement of Principles No. 27 of 2022

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 periodontitis or death from periodontitis with the circumstances of a person's relevant service:

  1. (1)
    having gingivitis involving the affected region of the periodontium for a continuous period of at least the 6 months before the clinical onset of periodontitis;
  2. (2)
    having a foreign body in contact with the affected region of the periodontium, on more days than not for a continuous period of at least 6 months before the clinical onset of periodontitis, and where the foreign body has been removed before the clinical onset of periodontitis, then that onset occurred within 4 weeks of removal;

    Note: Examples of a foreign body in contact with the periodontium include an osseointegrated implant or dental prosthesis, a removable dental prosthesis and an orthodontic appliance such as a separator or elastic band.

  3. (3)
    having an oral piercing adjacent to the affected region of the periodontium for a continuous period of at least the 6 months before the clinical onset of periodontitis;

    Note: oral piercing is defined in the Schedule 1 - Dictionary.

  4. (4)
    having trauma to the affected region of the periodontium within the 6 months before the clinical onset of periodontitis;

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

  5. (5)
    having surgery to the affected region of the periodontium within the 6 months before the clinical onset of periodontitis;
  6. (6)
    having neutropenia or agranulocytosis at the time of the clinical onset of periodontitis;

    Note: Causes of neutropenia or agranulocytosis include having an autoimmune disease or infection such as human immunodeficiency virus infection, and taking drugs such as clozapine, sulfasalazine, ticlopidine, methimazole, carbimazole and propylthiouracil.

  7. (7)
    having leukaemia at the time of the clinical onset of periodontitis;
  8. (8)
    having infection with human immunodeficiency virus at the time of the clinical onset of periodontitis;
  9. (9)
    having diabetes mellitus at the time of the clinical onset of periodontitis;
  10. (10)
    being obese for a continuous period of at least the 3 years before the clinical onset of periodontitis;

    Note: being obese is defined in the Schedule 1 - Dictionary.

  11. (11)
    having chronic renal failure at the time of the clinical onset of periodontitis;

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

  12. (12)
    having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical onset of periodontitis;

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

  13. (13)
    having smoked tobacco products: (a) in an amount of at least 2.5 pack-years before the clinical onset of periodontitis; and (b) if smoking has ceased before the clinical onset of periodontitis, then that onset occurred within 10 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

  14. (14)
    having severe malnutrition at the time of the clinical onset of periodontitis;
  15. (15)
    having severe vitamin C deficiency or vitamin D deficiency at the time of the clinical onset of periodontitis;

    Note: severe vitamin C deficiency and vitamin D deficiency are defined in the Schedule 1 - Dictionary.

  16. (16)
    consuming an average of at least 200 grams of alcohol per week for a continuous period of at least the 2 years before the clinical onset of periodontitis;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

  17. (17)
    having gingivitis involving the affected region of the periodontium for a continuous period of at least the 6 months before the clinical worsening of periodontitis;
  18. (18)
    having a foreign body in contact with the affected region of the periodontium, on more days than not for a continuous period of at least 6 months before the clinical worsening of periodontitis, and where the foreign body has been removed before the clinical worsening of periodontitis, then that worsening occurred within 4 weeks of removal;

    Note: Examples of a foreign body in contact with the periodontium include an osseointegrated implant or dental prosthesis, a removable dental prosthesis and an orthodontic appliance such as a separator or elastic band.

  19. (19)
    having an oral piercing adjacent to the affected region of the periodontium for a continuous period of at least the 6 months before the clinical worsening of periodontitis;

    Note: oral piercing is defined in the Schedule 1 - Dictionary.

  20. (20)
    having trauma to the affected region of the periodontium within the 6 months before the clinical worsening of periodontitis;

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

  21. (21)
    having surgery to the affected region of the periodontium within the 6 months before the clinical worsening of periodontitis;
  22. (22)
    having neutropenia or agranulocytosis at the time of the clinical worsening of periodontitis;

    Note: Causes of neutropenia or agranulocytosis include having an autoimmune disease or infection such as human immunodeficiency virus infection, and taking drugs such as clozapine, sulfasalazine, ticlopidine, methimazole, carbimazole and propylthiouracil.

  23. (23)
    having leukaemia at the time of the clinical worsening of periodontitis;
  24. (24)
    having infection with human immunodeficiency virus at the time of the clinical worsening of periodontitis;
  25. (25)
    having diabetes mellitus at the time of the clinical worsening of periodontitis;
  26. (26)
    being obese for a continuous period of at least the 3 years before the clinical worsening of periodontitis;

    Note: being obese is defined in the Schedule 1 - Dictionary.

  27. (27)
    having chronic renal failure at the time of the clinical worsening of periodontitis;

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

  28. (28)
    having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical worsening of periodontitis;

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

  29. (29)
    having smoked tobacco products: (a) in an amount of at least 2.5 pack-years before the clinical worsening of periodontitis; and (b) if smoking has ceased before the clinical worsening of periodontitis, then that worsening occurred within 10 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

  30. (30)
    having severe malnutrition at the time of the clinical worsening of periodontitis;
  31. (31)
    having severe vitamin C deficiency or vitamin D deficiency at the time of the clinical worsening of periodontitis;

    Note: severe vitamin C deficiency and vitamin D deficiency are defined in the Schedule 1 - Dictionary.

  32. (32)
    consuming an average of at least 200 grams of alcohol per week for a continuous period of at least the 2 years before the clinical worsening of periodontitis;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

  33. (33)
    having osteoporosis at the time of the clinical worsening of periodontitis;
  34. (34)
    inability to obtain appropriate clinical management for periodontitis;

Aggravation-only factors: the factors in subsections 9(17) to 9(34) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

Balance of Probabilities (BoP) — Statement of Principles No. 28 of 2022

34 factors

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

  1. (1)
    having gingivitis involving the affected region of the periodontium for a continuous period of at least the 6 months before the clinical onset of periodontitis;
  2. (2)
    having a foreign body in contact with the affected region of the periodontium, on more days than not for a continuous period of at least 6 months before the clinical onset of periodontitis, and where the foreign body has been removed before the clinical onset of periodontitis, then that onset occurred within 4 weeks of removal;

    Note: Examples of a foreign body in contact with the periodontium include an osseointegrated implant or dental prosthesis, a removable dental prosthesis and an orthodontic appliance such as a separator or elastic band.

  3. (3)
    having an oral piercing adjacent to the affected region of the periodontium for a continuous period of at least the 6 months before the clinical onset of periodontitis;

    Note: oral piercing is defined in the Schedule 1 - Dictionary.

  4. (4)
    having trauma to the affected region of the periodontium within the 6 months before the clinical onset of periodontitis;

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

  5. (5)
    having surgery to the affected region of the periodontium within the 6 months before the clinical onset of periodontitis;
  6. (6)
    having neutropenia or agranulocytosis at the time of the clinical onset of periodontitis;

    Note: Causes of neutropenia or agranulocytosis include having an autoimmune disease or infection such as human immunodeficiency virus infection, and taking drugs such as clozapine, sulfasalazine, ticlopidine, methimazole, carbimazole and propylthiouracil.

  7. (7)
    having leukaemia at the time of the clinical onset of periodontitis;
  8. (8)
    having infection with human immunodeficiency virus at the time of the clinical onset of periodontitis;
  9. (9)
    having diabetes mellitus at the time of the clinical onset of periodontitis;
  10. (10)
    being obese for a continuous period of at least the 3 years before the clinical onset of periodontitis;

    Note: being obese is defined in the Schedule 1 - Dictionary.

  11. (11)
    having chronic renal failure at the time of the clinical onset of periodontitis;

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

  12. (12)
    having inflammatory bowel disease or rheumatoid arthritis at the time of the clinical onset of periodontitis;
  13. (13)
    having smoked tobacco products: (a) in an amount of at least 5 pack-years before the clinical onset of periodontitis; and (b) if smoking has ceased before the clinical onset of periodontitis, then that onset occurred within 10 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

  14. (14)
    having severe malnutrition at the time of the clinical onset of periodontitis;
  15. (15)
    having severe vitamin C deficiency or vitamin D deficiency at the time of the clinical onset of periodontitis;

    Note: severe vitamin C deficiency and vitamin D deficiency are defined in the Schedule 1 - Dictionary.

  16. (16)
    consuming an average of at least 200 grams of alcohol per week for a continuous period of at least the 2 years before the clinical onset of periodontitis;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

  17. (17)
    having gingivitis involving the affected region of the periodontium for a continuous period of at least the 6 months before the clinical worsening of periodontitis;
  18. (18)
    having a foreign body in contact with the affected region of the periodontium, on more days than not for a continuous period of at least 6 months before the clinical worsening of periodontitis, and where the foreign body has been removed before the clinical worsening of periodontitis, then that worsening occurred within 4 weeks of removal;

    Note: Examples of a foreign body in contact with the periodontium include an osseointegrated implant or dental prosthesis, a removable dental prosthesis and an orthodontic appliance such as a separator or elastic band.

  19. (19)
    having an oral piercing adjacent to the affected region of the periodontium for a continuous period of at least the 6 months before the clinical worsening of periodontitis;

    Note: oral piercing is defined in the Schedule 1 - Dictionary.

  20. (20)
    having trauma to the affected region of the periodontium within the 6 months before the clinical worsening of periodontitis;

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

  21. (21)
    having surgery to the affected region of the periodontium within the 6 months before the clinical worsening of periodontitis;
  22. (22)
    having neutropenia or agranulocytosis at the time of the clinical worsening of periodontitis;

    Note: Causes of neutropenia or agranulocytosis include having an autoimmune disease or infection such as human immunodeficiency virus infection, and taking drugs such as clozapine, sulfasalazine, ticlopidine, methimazole, carbimazole and propylthiouracil.

  23. (23)
    having leukaemia at the time of the clinical worsening of periodontitis;
  24. (24)
    having infection with human immunodeficiency virus at the time of the clinical worsening of periodontitis;
  25. (25)
    having diabetes mellitus at the time of the clinical worsening of periodontitis;
  26. (26)
    being obese for a continuous period of at least the 3 years before the clinical worsening of periodontitis;

    Note: being obese is defined in the Schedule 1 - Dictionary.

  27. (27)
    having chronic renal failure at the time of the clinical worsening of periodontitis;

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

  28. (28)
    having inflammatory bowel disease or rheumatoid arthritis at the time of the clinical worsening of periodontitis;
  29. (29)
    having smoked tobacco products: (a) in an amount of at least 5 pack-years before the clinical worsening of periodontitis; and (b) if smoking has ceased before the clinical worsening of periodontitis, then that worsening occurred within 10 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

  30. (30)
    having severe malnutrition at the time of the clinical worsening of periodontitis;
  31. (31)
    having severe vitamin C deficiency or vitamin D deficiency at the time of the clinical worsening of periodontitis;

    Note: severe vitamin C deficiency and vitamin D deficiency are defined in the Schedule 1 - Dictionary.

  32. (32)
    consuming an average of at least 200 grams of alcohol per week for a continuous period of at least the 2 years before the clinical worsening of periodontitis;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

  33. (33)
    having osteoporosis at the time of the clinical worsening of periodontitis;
  34. (34)
    inability to obtain appropriate clinical management for periodontitis;

Aggravation-only factors: the factors in subsections 9(17) to 9(34) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

A VHC Diagnostic Assessment addresses each of these factors one by one against your service record and clinical history. See how a VHC DVA claim works, see all fees ($600 + GST per stage) or book an appointment.

About Dr Thomas Perkins

One doctor. Every report.

Founding doctor of the Veterans Health Centre in Ipswich, Queensland, and one of Australia's most experienced practitioners in veterans' medicolegal medicine.

Dr Perkins has spent more than thirteen years working exclusively with current and former ADF members — treating their conditions, writing their reports and navigating the DVA system alongside them. With over 100,000 claims submitted and 2,000 Permanent Impairment Assessments completed, he has seen precisely what separates an accepted claim from a rejected one at every level, from initial liability to the Veterans' Review Board.

Every chart review, diagnostic assessment, impairment rating and appeal that leaves this clinic is personally overseen by Dr Perkins. No template, no locum, no hand-off.

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