BiO-21 – A Cure or Curse?

The hog wild OTC sale of the tablets Bio-21, also marketed as teething-21, in Pakistan is an age-old issue that has never been highlighted with due significance. The active ingredients of Bio-21 include Calcarea Phosphorus (CalC Phos.) and Ferrous Phosphorium. Calc Phosphorus is a major component in most fertilizers, animal feed, glass manufacturing, and dental products, and has been advocated as a remedy for infant teething pain. This somewhat mythical quality has been proven to be incorrect.

Periodontal ligament (PDL) fibroblasts block osteogenic cells of periodontium by releasing active regulators, which keeps a tooth separated from the bone. Any sort of damage to this PDL results in the fusion of cementum and dentine to the alveolar bone, ultimately leading towards tooth ankylosis. This phenomenon is primarily observed in traumatized or reimplanted teeth. The deciduous tooth most likely to be affected by ankylosis is the second molar. The only treatment option is extraction, prior to the eruption of permanent second premolar, and the placement of a space maintainer. Moreover, radiographically, the phenomenon is only evident when located on the proximal surface of the root while hindering exfoliation of primary dentition due to diminished or ceased replacement root resorption.

Bio-21 has been observed to induce generalized ankylosis in primary dentition, and the unfavourable results are drastic. Partial or no root resorption leads to altered shedding timings resulting in profound esthetic and functional defects besides incurring out-of-the-pocket health expenditure in the form of Orthodontic treatment and other dental procedures. According to Human Phenotype Ontology (HPO), a database for collecting information on medical symptoms, 30-79 percent of the population suffering from ankylosis have abnormal tooth enamel and dentine.

Pain during primary dentition eruption is a natural process and symptoms may vary from child to child. It can be troublesome for some parents as the baby becomes cranky or irritable. Dental healthcare professionals must educate parents and the masses regarding the treatment options and the implications of consuming the drug. Best possible options to opt for pain relief in infants are painkillers i.e, Ibuprofen, Paracetamol and refrigerated teethers. Last but not the least, regulatory bodies must take stern steps to curtail the OTC sale of Bio-21 and other similar drugs.

                                                                       DR.MUHAMMAD WAQAS KHAWAJA

September 26, 2018

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