SOP Bulletin No. 57

4 — th Floor AMP Place, 10 Eagle St Brisbane  3 — rd Floor Blackburn House, 199 Grenfell St Adelaide

Intranet site: http://intranet/nat/comp/dp/Nop/dsu/dsudefault.htm

16 January 2002

THE FOLLOWING RMA SOPS ARE TO BE GAZETTED ON 16 January, 2002

IMPORTANT OPERATIONAL FEATURES

• These two conditions were previously covered by one SOP for inflammatory periodontal disease.
• The conditions may co-exist and both diagnoses may need to be made.  Gingivitis (inflammation of the gums) is very common.  Periodontitis is inflammation involving the bony and ligamentous support structures of the teeth.  It is far less common.
• The previous SOP had a causal factor only for inability to maintain oral hygiene (clean the teeth) for 90 days, plus a POW factor in the RH SOP.
• In the new gingivitis SOP:
• there is a “no cleaning of teeth” factor, with the time requirement now seven days
• a POW factor has not been included
• there are new causal factors covering: diabetes; foreign body in the gums; gum injury; HIV infection; leukaemia; pregnancy; and oral contraceptive use
• There are further causal factors that apply only to a severe and now rare form of gingivitis (acute necrotising ulcerative gingivitis, a.k.a. trench mouth, Vincent's gingivitis) - these are: smoking; a severe psychosocial stressor; and severe nutritional deficiency
• There are no worsening factors except inability to obtain appropriate clinical management.

• In the periodontitis SOP:
• There is a causal factor for gingivitis
• The other main causal factors cover smoking and diabetes
• Additional causal factors cover: severe nutritional deficiency; HIV infection; dental pulp disease; and, for periodontal abscess only, a foreign body or penetrating trauma
• There are worsening factors mirroring the causal factors, except for smoking and nutritional deficiency.

• This amendment corrects errors in the factors covering fractures [5(a)(i) and 5(b)].  Previously these factors referred to fractures of joints; they now correctly refer to fractures of bones.

• All these SOPs contain a diabetes mellitus factor.  The amendments remove the definition of diabetes mellitus from each SOP. 
• This has been done because the disease definition in the SOPs for diabetes mellitus was recently changed (instruments 91 and 92 of '01).  This meant that the definitions in the SOPs for diabetes and those in the SOPs with diabetes as a factor did not match.  The SOP factor definitions are unnecessary, so they have been deleted rather than updated.
• This change has no operational effect.  The diabetes mellitus SOP must still be applied when considering a relationship between diabetes and service.
• The RMA in future will not be including definitions for factors that are themselves the subject of a SOP. 
• There are 4 other SOPs with a diabetes factor where the same amendment is yet to be made.  This is because they are either under investigation by the RMA or still tabled in parliament.  The four SOPs involved are ischaemic heart disease, atherosclerotic peripheral vascular disease, carotid arterial disease and otitis externa.

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