Dental treatment guideline

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View our individual guidelines to focus on the topics that matter to you. These are also available in plain language versions which are easier to understand (called MyGuides).

Dental treatment guideline (PDF, 241KB)

MyGuide3: dentists (PDF, 155KB)

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• Definitions

  Defined terms are shown throughout in bold underlined text when they first appear.

  Dental treatment is treatment provided by a dental practitioner to a participant.

  Dental practitioner is a person who is registered under the Health Practitioner Regulation National Law as a dental practitioner as a:

  • dentist
  • dental specialist
  • dental hygienist
  • dental therapist
  • oral health therapist
  • dental prosthetist.

  Dental specialist includes any person who holds a Specialist Title as regulated under the Health Practitioner Regulation National Law by the Australian Dental Board (and in some cases Australian Medical Board), and for a particular dental specialty.

  Dental technician  is a person who works on instruction from a dental practitioner to create, modify or repair a range of oral devices which are designed to replace or repair missing teeth.

  General dentistry needs includes a participant’s need for routine procedures performed by dental practitioners which are not the result of the participant’s accepted injury and include:

  • diagnostic services (for example, oral examinations, consultations and reports)
  • radiological examinations and other diagnostic services (radiographs, bacteriological examinations)
  • dental care (removal of plaque, calculus, teeth whitening, fluoride treatments, fissures and/or tooth sealing, gum care including general periodontics)
  • dental surgery (wisdom tooth removal)
  • costs associated with dental care including toothbrushes, dental floss and mouthwash.

  Health Practitioner Regulation National Law is Queensland’s modified application of Health Practitioner Regulation National Law under the Health Practitioner Regulation National Law Act 2009 (Qld).

• Supporting a participant who needs dental treatment

  The NIISQ Agency will identify a participant’s needs for (or relating to) dental treatment and will fund these supports in accordance with the National Injury Insurance Scheme (Queensland) Act 2016 (the NIISQ Act), the National Injury Insurance Scheme (Queensland) Regulation 2016 (the NIISQ Regulation) and this guideline, and other relevant guidelines.

  There is a plain language version of this guideline which is shorter and uses simpler words. To access it, view MyGuide 3 – Dentists.

  This guideline should be read in conjunction with the Necessary and reasonable guideline.

• Approval for dental treatment

  For dental treatment to be funded under the NIISQ, the NIISQ Agency must provide written approval before the dental treatment is provided to the participant.

  Where dental treatment is required by a participant in an emergency and it is not possible to obtain prior written approval, the NIISQ Agency may waive the requirement for prior written approval. In these circumstances, the NIISQ Agency may still require additional information about the support when a provider of dental treatment requests payment from the NIISQ Agency.

• Dental treatment must be necessary and reasonable

  The National Injury Insurance Scheme (Queensland) Act 2016 and the National Injury Insurance Scheme (Queensland) Regulation 2016 describe how the NIISQ Agency decides whether a dental treatment is necessary and reasonable and can be funded.

  The NIISQ Agency has published a guideline which explains how it decides whether a support is necessary and reasonable, and is for a treatment, care and support need (see: Necessary and reasonable guideline).

  When the NIISQ Agency is assessing whether a participant’s needs for dental treatment are necessary and reasonable, it will give particular attention to the following:

  • whether the dental treatment will benefit the participant by assisting with the management of dental issues resulting from their accepted injury
  • whether the dental treatment is appropriate, having regard to:
    • whether it is consistent with current dental practices and other industry best practice (particularly, safety and efficacy considerations)
    • whether the participant is receiving similar dental treatment that is intended to meet their needs
    • whether there is evidence to support the effectiveness of the dental treatment
  • whether the provider is appropriately qualified (see: dental treatment must be provided by an appropriate provider)
  • whether the provider is appropriate for the participant
  • whether the dental treatment is a cost-effective way to meet the participant’s needs, having regard to the benefits that the dental treatment has for the participant.

  The NIISQ Agency will assess whether a participant’s needs for treatment, care and support is necessary and reasonable by considering whether the rehabilitation supports adhere to the nationally-recognised Clinical Framework for the Delivery of Health Services (see: Necessary and reasonable guideline and evidence-based interventions).

  The NIISQ Agency will fund the associated transport costs incurred by a participant for necessary and reasonable dental treatment (see: Transport-related expenses in the Attendant care and support services guideline).

• Assessment of needs for dental treatment

  In assessing a participant’s needs for dental treatment, the NIISQ Agency will ordinarily require information from a dentist or dental specialist to assist the NIISQ Agency to decide whether dental treatment is necessary and reasonable.

  Dental treatment can only be provided by certain providers. This includes services which are intended to assist the NIISQ Agency with the assessment of a participant’s treatment, care and support needs.

  Identifying a participant’s treatment, care and support needs is done in collaboration with the participant, their family and/or other informal supports, and providers.

  Information from a dental practitioner about needs for dental treatment

  The NIISQ Agency will generally require any information provided by a dental practitioner who treated the participant following the incident which caused the participant’s accepted injury.

  Where information about a participant’s needs for dental treatment is unavailable, the NIISQ Agency may fund an assessment including a written report provided by a dental practitioner, radiological examination, analysis and interpretation, clinical occlusal analysis and/or other diagnostic services.

  The NIISQ Agency requires information to assist in deciding whether dental treatment is necessary and reasonable (see: dental treatment must be necessary and reasonable). It also requires information on whether the need for dental treatment is directly related to the participant’s accepted injury (and if only partially, the extent to which the participant’s treatment, care and support needs are related to their accepted injury). The NIISQ Agency considers that the need for the dental treatment is directly related to a participant’s accepted injury when:

  • the incident which caused the participant’s accepted injury involved direct trauma to the participant’s face, mouth, jaw, oral cavity, head and/or neck
  • the participant’s treatment for their accepted injury requires dental treatment (for example, to manage the effects of certain medications which impact the participant’s oral health)
  • the participant’s capacity for self-care has been impacted, requiring dental treatment (for example, to assist with the effects of a traumatic brain injury)
  • information which assists the NIISQ Agency in deciding whether a dental treatment is necessary and reasonable (see: dental treatment must be necessary and reasonable).

  Dental treatment must be provided by an appropriate provider

  Dental practitioners, including dental specialists providing dental treatment do not need to be registered providers under the National Injury Insurance Scheme (Queensland) Act 2016 nor the National Injury Insurance Scheme (Queensland) Regulation 2016.

  However, all dental practitioners providing dental treatment remain subject to the Health Practitioner Regulation National Law.

  The NIISQ Agency expects dental practitioners to comply with their legal and professional obligations under the Health Practitioner Regulation National Law including (but not limited to):

  • maintaining appropriate professional indemnity insurance
  • comply with the shared Code of conduct published on the Australian Health Practitioner Regulation Agency’s website
  • comply with the scope of practice registration standard available from the Dental Board of Australia.

• Types of dental treatment funded under the NIISQ

  There is a broad range of dental treatment which may be funded for participants in the NIISQ including costs associated with the assessment, care planning and treatment for a participant’s dental treatment provided by dental practitioners providing the following services:

  • treatment of direct injuries to the head requiring dental treatment (dentistry, oral and maxillofacial surgery, prosthodontics)
  • diagnostic services required to understand how best to treat a participant’s injuries or conditions which are related to their accepted injury (dento-maxillofacial radiology, oral and maxillofacial pathology)
  • ongoing support related to the accepted injury, and tailored to the participant’s age, injuries and disability (oral medicine, paediatric dentistry, prosthodontics and special needs dentistry) including replacement of dentures lost or damaged in the event which caused the participant’s accepted injury.

  The NIISQ Agency may also fund services provided by a dental technician which complement support provided by a dental practitioner.

• Limitations on support for dental treatment

  The NIISQ Agency does not fund general dentistry needs, which are unrelated to a participant’s accepted injury. Where the injury has increased a participant’s general dentistry needs, and there is a written recommendation provided by a dental practitioner which clearly explains the need, the NIISQ Agency may contribute to the costs of general dental treatment.

• Dental treatment generally not funded by the NIISQ Agency

  The following is generally not considered necessary and reasonable treatment, care and support:

  • dental treatment that is required by a participant for reasons unrelated to their accepted injury
  • dental treatment that is for aesthetic purposes that are unrelated to a participant’s accepted injury
  • dental treatment provided outside of Australia (see: Participants travelling overseas guideline).