• 1.1The LSA considers TCS needs in connection with dental treatment to be necessary and reasonable when treatment is provided by an Appropriately Qualified dental practitioner or other specialist (such as an oral and maxillofacial surgeon) and is:
    • 1.1.1required as a direct result of the Motor Vehicle Injury;
    • 1.1.2related to, or caused by, side effects of Pharmaceutical Products required for the treatment of the Motor Vehicle Injury;
    • 1.1.3required because of failure to maintain dental health due to treatment related to the Motor Vehicle Accident;

For example, an extended stay in an intensive care unit.

  • 1.1.4required in addition to the level of pre-injury dental treatment (such as oral spasticity requiring more frequent dental treatment by a dental practitioner);
  • 1.1.5required 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
  • 1.1.6intended to restore a Participant’s dentition to a level that is consistent with their pre-injury standard of dental care.

  • 2.1Information required by the LSA to assess a Participant’s TCS needs for or in connection with dental treatment includes:
    • 2.1.1information relating to the Motor Vehicle Accident, to establish whether dental injuries may have occurred through direct trauma to the mouth or facial injuries;
    • 2.1.2information from a relevant 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;
    • 2.1.3information from any or all dentists or relevant medical practitioner where the Participant received dental treatment prior to their injury;
    • 2.1.4a dental consult that includes a fully itemised account or quotation from a registered dental practitioner or other Appropriately Qualified Medical Specialist;
    • 2.1.5an outline of the goals of the proposed treatment; and
    • 2.1.6information 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.
  • 2.2Information required by the LSA to assess a Participant’s TCS need in connection with dental treatment may include a second opinion or quote in circumstances where:
    • 2.2.1The relationship to the Motor Vehicle Injury is unclear; or
    • 2.2.2The LSA regards the dental treatment as complex or extensive.
  • 2.3The dental treatment must be requested prior to commencement in all circumstances unless the intervention is considered emergency treatment.

  • 3.1Where 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 if:
    • 3.1.1there is evidence of a direct trauma to the mouth from the accident; and
    • 3.1.2there is a direct impact on other accident-related dental treatment if the dentures were not replaced at the same time; or
    • 3.1.3there is a direct impact on the Participant’s Rehabilitation.

  • 4.1The following dental treatments are excluded and not considered necessary and reasonable TCS:
    • 4.1.1a treatment or service not directly related to the Motor Vehicle Injury;
    • 4.1.2a treatment or service solely for aesthetic purposes, such as teeth whitening;
    • 4.1.3a treatment or service that is of no clear benefit to a Participant; and
    • 4.1.4repeat 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).
  • 4.2The reasonable expenses in relation to the Participant’s assessed TCS needs in relation to dental treatment will not generally include:
    • 4.2.1a treatment or service inconsistent with the Participant’s pre-injury standard of dental care unless the reason for treatment or cost of treatment is assessed as being exacerbated or aggravated by the Motor Vehicle Injury, in which case the LSA may contribute (wholly or in part) depending on the impact of the Motor Vehicle Injury;
    • 4.2.2a treatment or service where there is no published evidence relating to its safety or effectiveness;
    • 4.2.3standard household expenses associated with routine at home dental care such as toothbrushes, toothpaste, dental floss and mouthwash.

Page last updated: 16 September 2022