1.1 The LSA considers treatment, care and support needs in connection with dental treatment to be necessary and reasonable when treatment is provided by a dental practitioner or other specialist (such as an oral and maxillofacial surgeon) registered with the AHPRA (or other appropriate professional body if the participant resides outside Australia) and is:
1.1.1 required as a direct result of the motor vehicle injury;
1.1.2 related to, or caused by, side effects of medications for the motor vehicle injury;
1.1.3 required because of failure to maintain dental health due to treatment following the motor vehicle accident (such as an extended stay in an intensive care unit);
1.1.4 required in addition to the level of pre-injury routine dental treatment (such as oral spasticity requiring more frequent dental treatment by a dental practitioner);
1.1.5 required to ensure that other forms of dental treatment can be provided (such as a participant with traumatic brain injury requiring a general anaesthetic to treat dental caries); or
1.1.6 intended to restore a participant’s dentition to a level that is consistent with their pre-injury standard of dental care.
1.2 The following dental treatments are not considered necessary and reasonable treatment, care and support needs:
1.2.1 a treatment or service solely for aesthetic purposes, such as teeth whitening;
1.2.2 a treatment or service that is of no clear benefit to a participant; and
1.2.3 repeat treatment required due to a participant’s lack of dental hygiene, unless the reason for treatment is assessed as related to the motor vehicle injury (such as cognitive and behavioural issues associated with traumatic brain injury).
1.3 The reasonable expenses in relation to the participant’s assessed treatment, care and support needs in relation to dental treatment will not generally include:
1.3.1 a treatment or service inconsistent with the participant’s pre-injury standard of dental care unless the reason for treatment is assessed as being exacerbated or aggravated by the motor vehicle injury;
1.3.2 a treatment or service where there is no published evidence relating to its safety or effectiveness;
1.3.3 fees associated with non-attendance (unless the reason for non-attendance is beyond the participant’s control); and
1.3.4 standard household expenses associated with dental care such as toothbrushes, toothpaste, dental floss and mouthwash.
2.1 Information required by the LSA to assess a participant’s treatment, care and support needs for or in connection with dental treatment includes:
2.1.1 information relating to the motor vehicle accident, to establish whether dental injuries may have occurred through direct trauma to the mouth or facial injuries;
2.1.2 information from a medical practitioner as to the likely cause of the presenting dental needs, if the participant has pre- or co-existing medical conditions that may impact on their needs for or in connection with dental treatment;
2.1.3 information from any or all dentists where the participant received treatment prior to their injury;
2.1.4 information about the participant’s injury related needs and the ability to perform, or be assisted with, any recommended dental hygiene that the treatment may require.
3.1 Where the participant required dentures prior to the motor vehicle accident, the LSA will replace dentures lost or damaged in the motor vehicle accident, in hospital or inpatient rehabilitation.
3.2 The LSA will also modify or replace dentures, following the motor vehicle accident if required as a result of the injuries.