ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Gabapentin Is as Effective as an Occlusal Appliance in Controlling Nighttime Masticatory EMG Activity
Clinical Question In a patient with fixed orthodontic bands and nighttime parafunctional habits, is gabapentin as effective and safe as an oral appliance in reducing levels of nighttime masticatory EMG activity?
Clinical Bottom Line Gabapentin (200 or 300 mg at bedtime) is a good treatment option for reducing nighttime masticatory EMG activity when an occlusal appliance cannot be used; it also has a good safety profile.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22946979Madani/201220 patients (stabilization splint group [n = 10] and gabapentin group [n = 10])Randomized Controlled Trial
Key resultsThe number of sleep bruxism episodes per hour and per night were significantly reduced (p < 0.05) for both groups. The mean intensity of the masseter muscle contractions during sleep bruxism episodes was also significantly reduced for both groups. There was no significant difference between the two groups concerning these variables, suggesting that they are equally effective.
#2) 24806220Fan/20146 randomized controlled trials that compared gabapentin 1800 mg/day to placebo for post-herpetic neuralgiaMeta-Analysis
Key resultsGabapentin taken at 1800 mg per day was found to be a safe medication. The risk ratio for total adverse effects was 1.28 (95% confidence interval, 1.16-1.42).
Evidence Search (("gabapentin" [Supplementary Concept]) AND "Occlusal Splints"[Mesh]) AND "Bruxism"[Mesh] and Gabapentin and safety
Comments on
The Evidence
Madani and co-authors did a randomized controlled trial of an alternative treatment for nocturnal parafunctional habits, providing a high level of evidence. In situations in which an occlusal appliance cannot be worn, 200 or 300 mg of gabapentin at bedtime should provide a similar reduction in nighttime masticatory activity as an occlusal appliance. This clinical trial only had 10 subjects in each group and was a single-blind trial, so further studies are merited. Fan and co-authors showed that gabapentin has a good safety profile when taken at 1800 mg per day. This suggests the 200- to 300-mg dose per day taken to decrease nocturnal parafunctional habits would also have a good safety profile.
Applicability For patients who awaken with TMD symptoms and are unable to wear an occlusal appliance, gabapentin (200 or 300 mg at bedtime) is a good treatment option. Gabapentin is a safe medication with minimal side effects. It has a generic formulation, so it should be relatively inexpensive. It is recommended that gabapentin be used only as an interim therapy until the patient is able to wear an occlusal appliance.
Specialty/Discipline (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords Sleep bruxism/drug therapy, occlusal appliances, occlusal splints, gabapentin
ID# 2762
Date of submission: 09/16/2014spacer
E-mail patelsg@livemail.uthscsa.edu
Author Supriya Patel
Co-author(s) Leigh Veilleux
Co-author(s) e-mail MartinLA@livemail.uthscsa.edu
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail WrightE2@uthscsa.edu
Basic Science Rationale
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