The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A hearing was held on December 13, 2005, at the worker's request. The Panel discussed this appeal on December 13, 2005 and again on May 23, 2006.

Issue

Whether or not the current dental treatment the worker is receiving to her front teeth is related to the April 11, 1989 compensable injury.

Decision

That the current dental treatment the worker is receiving to her front teeth is not related to the April 11, 1989 compensable injury.

Decision: Unanimous

Background

On April 11, 1989, the worker chipped her two front teeth as a result of a work related accident. No claim was pursued with the Workers Compensation Board (WCB) as the worker decided to submit a claim to a private insurer.

In 2005, the WCB received a billing for dental treatment. On January 14, 2005, a WCB adjudicator contacted the worker and obtained information regarding the injury. The worker advised that her front upper teeth were capped as a result of an accident and that she claimed through her company disability insurer. After the injury, it was noted that a pocket had developed behind one of the teeth that had been repaired. The worker became aware of the pocket and tried to be consistent with dental hygiene. The condition of her gums deteriorated, resulting in the need for the current treatment. The worker indicated that she did not lose time from work to attend dental appointments and there had been no new accidents or incidents in the workplace.

Based on the above information, the WCB adjudicator gathered additional information from the worker's treating dentist which was reviewed by a WCB dental consultant. On February 9, 2005, the consultant indicated that the worker's current problems appeared to be related to an ongoing TMJ [temporal mandibular joint] problem which was not caused by the accident that chipped her teeth. The consultant was of the opinion that the treatment for the bone loss had not occurred as a direct result of the accident. On February 11, 2005, the WCB adjudicator advised the worker that the WCB would not accept financial responsibility for the proposed dental work. On April 27, 2005, the worker appealed the decision to Review Office.

On July 6, 2005, Review Office asked the WCB's dental consultant to review the worker's letter of April 27, 2005 and to comment on whether the worker's information changed his previous opinion. In a response dated July 8, 2005, the dental consultant stated:

"I have no doubt teeth have to be extracted due to bone loss. In Dr. [dentist's name] report he says bone support for teeth is OK up until 2000 some eleven years after the accident. For bone loss to show up eleven years after the accident it is my opinion that it is caused by something else. Two possibilities are oral hygiene or T.M.J. problems usually associated with clenching and/or grinding habit. Dr. [dental specialist] in his report dated Sept 1991 mentions crowding of the front teeth, this could well make it harder to keep up good dental hygiene."

In a decision dated July 14, 2005, Review Office stated that it accepted the opinion of the WCB's dental consultant and confirmed the case manager's decision that the worker's current dental treatment to her front teeth is not related to the April 11, 1989 accident. On September 5, 2005, the worker appealed Review Office's decision and an oral hearing was held on December 13, 2005.

Following the hearing, the appeal panel met to discuss the case. It decided to arrange for the worker to be examined by an independent oral surgeon. This examination later took place in February 2006 and the oral surgeon's report of April 17, 2006 was forwarded to the worker for comment. On May 23, 2006, the panel met to further discuss the case and rendered its final decision.

Reasons

The worker has appealed the WCB's decision that her current dental treatment is not related to her April 11, 1989 compensable injury. For the worker's appeal to be successful, the panel must find that the current dental treatment is required as a result of a compensable injury. The panel did not arrive at this conclusion. The panel finds on a balance of probabilities that the worker's current dental treatment is not related to a compensable injury.

Worker's Position

The worker attended the hearing, provided the panel with information regarding her dental condition and answered questions posed by the panel.

The worker described her early symptoms and the development of her current problem.

She also described the treatments she has received. The worker disagreed with the suggestion that her current problem may be due to TMJ or poor hygiene.

She submitted that if the accident had never happened, she would never have had the current problem.

Employer's Position

The employer, while not represented at the hearing, provided a written submission to the appeal panel. The employer agreed with the WCB decision that the worker's current dental treatment is not related to her compensable injury as a cause and effect relationship has not been established.

Analysis

As noted in the background, the panel asked that the worker be examined by a independent oral surgeon. The examination took place and the panel has received and considered the oral surgeon's report.

The panel finds, on a balance of probabilities, that the dental treatment the worker is receiving currently to her front teeth is not related to her April 11, 1989 compensable injury. The panel relies upon the opinion of the independent oral surgeon in reaching this conclusion. In a report dated April 17, 2006 the dental surgeon wrote:

"Specifically, Ms. [worker's] diagnosis is localized periodontitis involving teeth # 12, 11, 21, and 22. As to whether this dental condition is a result of the workplace injury in April of 1989 is speculative.

I seriously doubt that the bone loss/periodontitis is directly related to her initial traumatic injury (possible, but I feel it is extremely unlikely). It is possible however, that the crowns which were placed predisposed Ms. [worker] to the development of periodontitis. Periodontitis can develop quite rapidly and can also have periods of quiescence with no significant bone loss over short or long periods of time. The crowns specifically would not cause the periodontal problem but the margin, contour etc. can predispose to an environment where periodontitis is more likely to occur."

The panel attaches significant weight to the opinion of the WCB dental consultant noted in the background to the decision.

The appeal is denied.

Panel Members

A. Scramstad, Presiding Officer
J. MacKay, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

A. Scramstad - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 15th day of June, 2006