When an employee in your dental practice is injured, you face a vital decision. You can either follow the proper procedure to help your employee get prompt, appropriate medical care. Or you can delay taking action--or take the wrong action--and make a bad situation worse.

The stakes are high.

Make the right moves and you can help your injured staff members recover faster--and possibly lower your workers' comp premium over the long run. But your problems will feed on themselves if you mismanage an employee's injury.

Here's the key: Report an injured employee's claim to Zenith immediately. This helps us gather facts, oversee your injured employee's health care and set the stage for a speedy return to work.

Please read these accounts of actual claims from our files. As you can see, you can influence whether a claim has a happy ending--or turns into a costly disaster.

CLAIM 1: Teamwork Pays Off

In May 2003, a dental hygienist felt pain in her right elbow. Zenith was notified of the claim promptly and referred the hygienist to a physician. The diagnosis: epicondylitis.

Zenith's claims team, including an examiner and nurse case manager, arranged for the hygienist to see a hand specialist who provided excellent medical care. The doctor advised the employee to take five days off work to rest her elbow, which she did. With her doctor's input, Zenith set up a treatment plan of physical therapy, a splint and cortisone shots if needed--all while the employee gradually returned to work.

Meanwhile, Zenith's return-to-work team conducted an on-site ergonomic evaluation. They helped the dentist modify the hygienist's desk so she could do her job without aggravating her elbow.

Everyone supported the hygienist's recovery. The dentist showed genuine concern, Zenith's staff answered her questions and guided her care, and her Zenith-approved medical team came through for her.

As a result, she happily returned to her job quickly and safely. Zenith closed the claim in October 2003 after paying about $4,000. The hygienist sustained no permanent disability and has no need for further medical care.

What went right?

• The dentist reported the claim immediately.
• Zenith redirected the hygienist to a qualified hand specialist.
• The dentist cooperated with Zenith's return-to-work staff and provided suitable transitional work.
• Zenith's claims team agreed on an aggressive treatment plan based on medical protocols.
• The dentist stayed in touch with the employee during her injury, showing care and concern for her.
• Zenith stayed in touch with the employee, the dentist and her doctor.

CLAIM 2: Bad Moves, Bad Results

In early 2002, a dental assistant complained of pain in her neck, back, chest and head due to the repetitive nature of her job. Rather than notify Zenith, her employer sent her to a chiropractor on his own. That didn't help, and her condition worsened.

The dentist didn't report the claim to Zenith until August 2003. By that time, it was too late for Zenith to investigate it properly. Even though Zenith found the basis of the claim questionable; the opportunity to deny the claim was lost. (Zenith has 90 days from the date that an employer learns of a claim to deny it; after 90 days, Zenith loses its chance to deny a questionable claim.)

Despite Zenith's efforts to redirect treatment at this late stage to appropriate medical specialists, the employee continues to complain of injuries and shows no signs of improvement. Looking ahead, it's likely that the employee will need neck surgery. Zenith expects to pay between $100,000 and $200,000 on this case.

What went wrong?

• The dentist did not report the claim to Zenith for over a year, thus preventing Zenith from denying it.
• The dentist provided care on his own, thus preventing Zenith's early intervention to reduce injury severity.
• The employee will probably suffer permanent disability due to the questionable care she received before Zenith was notified of the claim.
• Zenith anticipates paying extended temporary disability costs and steep medical costs associated with surgery, along with high permanent disability costs, due to the severity of the claim. There's a good chance much of these costs could've been prevented had the dentist reported the claim promptly to us.

It's no mystery why dental hygienists tend to suffer musculoskeletal disorders (MSDs). Their work requires bending, stretching and forceful repetitive movements that place them at high risk of injury. The good news for dental workers is that they can take simple steps to reduce the risk of MSDs. After years of research, Zenith has found that dental professionals who follow these 14 tips can work more effectively while reducing the risk factors that lead to MSDs.

1. Use "neutral" hand postures when possible. Avoid bent hand/wrist positions that place extra stress on muscles, nerves and tendons.
2. Wear gloves that do not resist your hands' natural movements. Gloves that fit a bit loosely may be better than tight ones. Consider using right- and left-fitting gloves instead of ambidextrous types.
3. Use ultrasonic scaling devices when appropriate, especially for heavy, tenacious calculus deposits. This minimizes repetitive stress on the fingers, hand and wrist.
4. Move around the patient every few minutes so that you don't remain in a static position for too long--alternate standing and sitting when possible.
5. Use sharp instruments. An instrument with a sharp cutting edge decreases the number of strokes required to remove deposits, reduces the pressure you need to apply against the tooth and offers a more relaxed grasp and controlled stroke. Sharpen instruments often.
6. Minimize fatigue by choosing the right instruments. Solid-core instruments tend to increase hand fatigue compared to lighter hollow-handle instruments. Small-diameter handles decrease control and increase muscle fatigue while large-diameter handles maximize control and reduce muscle cramping. Knurled or textured handles maximize control and decrease hand fatigue.
7. Use task chairs that provide the best access to the patient's mouth. A good chair:
   • allows you to sit close to the patient's head or straddle the headrest when sitting behind the patient;
   • adjusts up or down to allow your thighs to be relatively horizontal with both feet flat on the floor;
   • has a footrest, such as a metal ring around the chair legs; and provides armrests for elbow support that do not block access to the patient.
8. Only use the force necessary to accomplish the task. Use mechanical equipment that's in good working order and that's regularly lubricated so that you can activate controls with minimal effort.
9. Schedule enough time between patients for your muscles and tendons to recover from stress. Spread out difficult or heavy-calculus patients so they're not scheduled back-to-back.
10. Take frequent rest breaks, particularly if experiencing fatigue, soreness or pain. Whenever possible, use the "other" hand or try a different, less fatiguing procedure.
11. Patient education is an important element of your MSD prevention plan. Encourage patients to return for frequent cleanings. This reduces the strenuous work needed to treat excessive calculus buildup. Educating patients also gives you a chance to rest your hands and wrists during scaling procedures.
12. Think holistically. MSDs can result from diabetes, rheumatoid arthritis or previous trauma. By eliminating or reducing repetitive hand/wrist movements off the job (such as knitting, tennis, typing or writing), you can cut down on work-related MSD injuries.
13. Control sources of mental stress as much as possible. Professional counseling or stress management workshops may help.
14. Engage in physical conditioning to build endurance, reduce body tension and improve the body's ability to regenerate. Aerobics, stretching, yoga and even brief hand/wrist exercises during scaling procedures can help prevent serious problems.