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Factsheet HSV150 - Bruxism and Access to Dental Treatment

Purpose

This Factsheet describes entitlements under the DVA dental program if you have Bruxism.

What is bruxism?

Bruxism is a specific medical condition that you may apply to have approved as an accepted condition. Under the 2016 DVA Statement of Principles, Bruxism is defined as, ‘a disorder of jaw muscle activity characterised by repetitive, involuntary clenching or grinding of the teeth or by bracing or thrusting of the mandible [lower jaw], occurring during wakefulness or sleep.’

DVA currently classifies Bruxism as a mental health condition based on compliance with international convention. This means that DVA funded treatment for Bruxism is mental health focused and provided by a mental health practitioner such as a Psychologist or Psychiatrist. See Factsheet HSV99 — Mental Health Support for information and services that you can access to assist with your mental health.

A consequence of your bruxism may include cracked, broken or worn teeth. These dental conditions are caused by the excessive or long term grinding of the teeth and jaw.

Access to the DVA dental program.

Having an accepted condition of Bruxism does not automatically entitle you to dental treatment.  Access varies depending on whether you are a Gold card or White card holder.

Gold Card holders

Your card type covers all conditions including the dental consequences of bruxism.  Some restrictions may apply and these are described in the section below.

For information about the Gold Card, see Factsheets HSV59 — Eligibility for the DVA Health Card/Veteran Card — All Conditions (Gold) or Totally & Permanently Incapacitated (Gold) and HSV60 — Using the DVA Health Card/Veteran Card — All Conditions (Gold) or Totally & Permanently Incapacitated (Gold)

White Card holders

Your card only allows you to receive treatment for your accepted condition. Access to dental treatment depends on you having an accepted dental condition.

White card holders with an accepted dental condition are eligible to receive dental treatment for the dental consequences of their Bruxism. Some restrictions may apply and these are described in the section below.

White Card holders who do not have an accepted dental condition are not eligible to access dental treatment for cracked, broken or worn teeth due to their bruxism.  In this case, you will need to submit a new claim for acceptance of a dental condition in order to access the program.

The only exception to this is that you may be eligible for provision of a mouth guard (occlusal splint) to address bruxism induced by stress or anxiety. You should seek advice from your medical practitioner regarding the need for a mouth guard.

For more information about the White Card, see Factsheet HSV61 — DVA Health Card/Veteran Card — Specific Conditions (White)

Allied Veteran

If you are an allied veteran, you are eligible for treatment of war caused disabilities accepted by your country of enlistment. See Factsheet HSV62 — Commonwealth and Other Allied Veterans for information about the services available.

What restrictions apply?

A key restriction is the Annual Monetary Limit (AML).

The AML:

  • is a legislatively imposed financial limit that applies to all DVA clients except where an exemption exists.
  • limits the amount of funding that DVA will approve for a small number of high cost items such as crowns and bridges.
  • is an annual limit that operates on a calendar year basis and is not cumulative, so any portion not expended during the year cannot be used in subsequent years.
  • is waived for DVA clients who meet the following criteria:
    • are ex-POW
    • have a specific dental condition as an accepted condition
    • have cancer affecting the mouth
  • increases each year by a small amount and your Dentist will be able to advise you what the current AML is.

For information on restrictions that may apply under DVA’s dental implant policy, see Factsheet HSV97 — Dental Implants for the Veteran Community

The table below describes the eligibility criteria and restrictions regarding the funding of dental treatment for clients with Bruxism.

Card holder type and accepted conditions Conditions covered and dental policies that apply
Gold card holder – Bruxism, but no accepted dental conditions
  • All conditions covered
  • AML applies
  • Implant policy applies - single tooth implants are limited to two per two years
Gold card holder – Bruxism and accepted dental conditions
  • All conditions covered
  • AML does not apply
  • Implant policy applies - single tooth implants are limited to two per two years

White Card holder – Bruxism, but no accepted dental conditions

  • No access to the dental program
White card holder – Bruxism and accepted dental conditions
  • Only accepted dental conditions can be treated
  • AML does not apply
  • Implant policy applies - single tooth implants are limited to two per two years

More Information

DVA General Enquiries

Phone: 1800 555 254 *

Email: GeneralEnquiries@dva.gov.au

DVA Website: www.dva.gov.au

Factsheet Website: www.dva.gov.au/about-dva/dva-factsheets

* Calls from mobile phones and pay phones may incur additional charges.

Open Arms Veterans and Veterans Families Counselling

A range of counselling services are available to veterans and their families through Open Arms.

Phone: 1800 011 046 *

Email: openarms.coord@dva.gov.au

Open Arms Website: www.openarms.gov.au

At Ease Website: www.at-ease.dva.gov.au

Related Factsheets

Disclaimer

The information contained in this Factsheet is general in nature and does not take into account individual circumstances. You should not make important decisions, such as those that affect your financial or lifestyle position on the basis of information contained in this Factsheet. Where you are required to lodge a written claim for a benefit, you must take full responsibility for your decisions prior to the written claim being determined. You should seek confirmation in writing of any oral advice you receive from DVA.

 

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7 November 2019