Denise Benko remembers the day the bike messenger was brought into Mercy Hospital's emergency department.

	John Beale/Post-Gazette
	Dr. Kip Benko with The Dental Box, used by emergency rooms to treat people with dental problems.

He was zooming over Downtown streets to the next delivery when somebody in a parked car opened the side door.

Wham! The messenger went flying over the handlebars. A helmet protected his head from major injury, but the blow broke off four of his front teeth at the gum line.

Luckily for the cyclist, Mercy had The Dental Box, a kit packed with adhesives, preservation solutions and other equipment designed to handle such emergencies.

The original teeth couldn't be reattached, but the quick intervention preserved the roots, minimizing damage and reconstruction, said Benko, a registered nurse and former manager of the emergency department.

Patients with knocked out, fractured or loosened teeth, abscesses, deep infections, dry sockets or cuts in the mouth frequently make their way to hospital emergency rooms, particularly at night or on weekends.

And most ERs are poorly prepared to handle such cases, according to a study in a recent Annals of Emergency Medicine.

Nationally, an average of 738,000 people each year visited hospital ERs with tooth pain or mouth injuries between 1997-2000, according to data analyzed from a survey conducted by the National Center for Health Statistics.

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The study by Dr. Charlotte Lewis and her colleagues at the University of Washington learned that those with Medicaid or no insurance were significantly more likely to visit the hospital with tooth problems. The researchers recommended that ERs be better prepared for basic dental treatment, as well as making sure patients receive the follow-up care they need.

Most ER doctors can do little more than administer pain medication or antibiotics to hold patients over until Monday morning when they can see their regular dentist. Yet, without timely treatment, a tooth that could be saved is lost.

No dentist, no insurance

In a dental emergency, patients are supposed to call their dentist. The American Dental Association requires dentists to provide emergency care.

"A lot of dentists have a group of dentists that they work with in terms of being on call to treat emergencies," said Dr. John Kokai, practicing dentist and spokesman for the Pennsylvania Academy of General Dentistry.

"It's true that people have dentists," said Dr. Kip Benko, an ER doctor for 10 years at Mercy who is married to Denise. "It's true that dentists are supposed to be on call 24 hours for their patients in an emergency."

But "25 percent of people don't have dental insurance and an even higher percentage don't have dentists," he said.

Many patients also don't realize their dentists can be reached during off-hours to handle emergencies.

"We end up taking care of a lot of that stuff and then referring them to dental clinics."

Benko's residency program, like those for other physicians, provided no training for dental emergencies.

But he's fortunate: his father, sister and college roommate are dentists, and his brother is an orthodontist. He always was on the phone with them getting advice.

Soon he began keeping certain glues, pastes and anesthetics in his locker at Mercy to treat these dental emergencies.

Then Mercy told him: "If you're going to keep this in your locker, let's make it official. Let's put together a kit,'' Kip Benko said. "So that's what I did.''

Benko would talk about his kit when he lectured on emergency medicine at national conferences. Other ER physicians asked him how they could put together their own kits.

So five years ago the Benkos started marketing The Dental Box to ERs, clinics and private practices nationwide. Interest has grown dramatically. They estimate that 10 percent of hospital emergency departments in the country have a box. The CIA has three boxes. The Benkos have also sold two boxes in Canada and two in Turkey.

The box comes with special instruments and materials, as well as laminated instruction cards. Doctors must be trained to use the equipment, bringing added awareness about how to handle dental emergencies, said Denise Benko, who retired from Mercy to operate the business.

An important feature is a tooth preservation kit. When a patient comes in with his or her knocked-out tooth, ER staff immediately place the tooth in what looks like a contact lens case filled with a solution rich in nutrients to help preserve the tooth.

Patients with fractured teeth are commonly seen, as are those complaining of jaw or sinus pain that turn out to be caused by infected teeth.

Dry sockets, which are incredibly painful, also are seen. After a tooth is pulled for whatever reason, a blood clot forms over the nerve, sealing the surface. Smoking or drinking with a straw can sometimes dislodge the clot, exposing the sensitive nerve. The kit has a paste that doctors use to cover the socket.

"We have everything in The Dental Box to take care of those things temporarily until they can get back to see their dentist," Kip Benko said.

The importance of dental medicine in the ER also is gaining recognition.

University of Pittsburgh's residency program in emergency medicine and a similar program in North Carolina have incorporated dental emergencies in their training.

"The whole intent of the dental box is really to improve the standard of care in emergency departments so that the patients are definitely happier,'' said Denise Benko. "We're working hand in hand with dentists.''