In some bird species, diclofenac causes accumulation of uric acid crystals in organs, especially kidneys, triggering acute renal necrosis and visceral gout. Vultures, among other carrion-eating birds, are known to scavenge deceased livestock. In South Asia in the 2000s, vulture populations were decimated by feeding on dead livestock that had been treated with diclofenac. Society and culture
History
In the United States, 1% diclofenac gel was approved by the FDA in 2007. It was approved as a prescription drug and was indicated for the relief of the pain of osteoarthritis of joints responsive to topical treatment; in particular, it was prescribed for the joints in the hands, knees and feet. It has not been shown to work for strains, sprains, bruises or sports injuries. It was intended for the temporary relief of joint pain due to the most common type of arthritis, osteoarthritis. In February 2020, the gel became an over-the-counter drug and the FDA granted the approval of the nonprescription product to GlaxoSmithKline plc. Formulations and trade names
The name "diclofenac" derives from its chemical name: 2-(2,6-dichloranilino) phenylacetic acid. Diclofenac was first synthesized by Alfred Sallmann and Rudolf Pfister and introduced as Voltaren by Ciba-Geigy (now Novartis) in 1973, then in 2015 it was bought by GlaxoSmithKline.Voltaren and Voltarol contain the sodium salt of diclofenac. In the United Kingdom, Voltarol can be supplied with either the sodium salt or the potassium salt, while Cataflam, sold in some other countries, is the potassium salt only.
The extraction of a maxillary tooth (typically a maxillary first molar which lies close to the lowest point of antral floor although any premolar or molar can be affected) is the most common cause of an OAC (which can then progress to an OAF as described above). Extraction of primary teeth are not considered a risk of OAC due to the presence of developing permanent teeth and the small size of the developing maxillary sinus. Other causes
Other causes of an OAC are: maxillary fractures across the antral floor typically Le Fort I, displacement of posterior maxillary molar roots into antrum and direct trauma. An OAC can happen for many other more unusual reasons, such as acute or chronic inflammatory lesions around the tip of a tooth root which is in close proximity with the maxillary antrum, destructive lesions/tumours of the maxilla, failure of surgical incisions to heal (e.g. Caldwell-luc antrostomy), osteomyelitis of the maxilla, careless use of instruments during surgical procedures, Syphilis, implants and as a results of complex surgery (for example removal of a large cysts or resections of large tumours involving the maxilla. Diagnosis
Clinical examination and x rays can help diagnose the condition. For examples :
Valsalva test (nose blowing test): Ask the patient to pinch the nostrils together and open the mouth, then blow gently through the nose. Observe if there is passage of air or bubbling of blood in the post extraction alveolus as the trapped air from closed nostrils is forced into the mouth through any oroantral communication.