Tooth wear
Meaning of tooth wear: 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.
Reasonable Hypothesis (RH) — Statement of Principles No. 52 of 2017
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 tooth wear or death from tooth wear with the circumstances of a person's relevant service:
- (1)for dental abrasion only, breathing dust in air at a concentration of greater than five milligrams per cubic metre: (a) for a cumulative period of at least 10 000 hours before the clinical onset of tooth wear; and (b) where that exposure has ceased, the clinical onset of tooth wear has occurred within six months of cessation;
Note: dental abrasion and dust are defined in the Schedule 1 - Dictionary.
- (2)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.
- (3)for dental erosion only: (a) consuming an average of at least 750 millilitres per day of any combination of drinks from the specified list of erosive drinks: (i) for a continuous period of at least two 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; (b) having 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 six months before the clinical onset of tooth wear; (f) having hyperemesis gravidarum within the three months before the clinical onset of tooth wear; (g) swimming in a swimming pool with a pH below 5.5 for a cumulative period of at least 25 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 six months 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 (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 1 000 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: dental erosion and specified list of erosive drinks are defined in the Schedule 1 - Dictionary.
Note: xerostomia is defined in the Schedule 1 - Dictionary.
Note: hyperemesis gravidarum is defined in the Schedule 1 - Dictionary.
Note: specified list of drugs is defined in the Schedule 1 - Dictionary.
Note: fumes and specified list of acidic substances are defined in the Schedule 1 - Dictionary.
- (4)for dental abrasion only, breathing dust in air at a concentration of greater than five milligrams per cubic metre: (a) for a cumulative period of at least 10 000 hours before the clinical worsening of tooth wear; and (b) where that exposure has ceased, the clinical worsening of tooth wear has occurred within six months of cessation;
Note: dental abrasion and dust are defined in the Schedule 1 - Dictionary.
- (5)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.
- (6)for dental erosion only: (a) consuming an average of at least 750 millilitres per day of any combination of drinks from the specified list of erosive drinks: (i) for a continuous period of at least two 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; (b) having 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 six months before the clinical worsening of tooth wear; (f) having hyperemesis gravidarum within the three months before the clinical worsening of tooth wear; (g) swimming in a swimming pool with a pH below 5.5 for a cumulative period of at least 25 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 six months 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 (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 1 000 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: dental erosion and specified list of erosive drinks are defined in the Schedule 1 - Dictionary.
Note: xerostomia is defined in the Schedule 1 - Dictionary.
Note: hyperemesis gravidarum is defined in the Schedule 1 - Dictionary.
Note: specified list of drugs is defined in the Schedule 1 - Dictionary.
Note: fumes and specified list of acidic substances are defined in the Schedule 1 - Dictionary.
- (7)inability to obtain appropriate clinical management for tooth wear;
Aggravation-only factors: the factors in subsections 8(4) to 8(7) 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. 53 of 2017
5 factors
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; (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; (f) having hyperemesis gravidarum within the three months before the clinical onset of tooth wear; (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 (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: dental erosion and specified list of erosive drinks are defined in the Schedule 1 - Dictionary.
Note: xerostomia is defined in the Schedule 1 - Dictionary.
Note: hyperemesis gravidarum is defined in the Schedule 1 - Dictionary.
Note: specified list of drugs is defined in the Schedule 1 - Dictionary.
Note: fumes and specified list of acidic substances are defined in the Schedule 1 - Dictionary.
- (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; (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; (f) having hyperemesis gravidarum within the three months before the clinical worsening of tooth wear; (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 (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: dental erosion and specified list of erosive drinks are defined in the Schedule1 - Dictionary.
Note: xerostomia is defined in the Schedule 1 - Dictionary.
Note: hyperemesis gravidarum is defined in the Schedule 1 - Dictionary.
Note: specified list of drugs is defined in the Schedule 1 - Dictionary.
Note: fumes and specified list of acidic substances are defined in the Schedule 1 - Dictionary.
- (5)inability to obtain appropriate clinical management for tooth wear;
Aggravation-only factors: the factors in subsections 8(3) to 8(5) 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.
