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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) 22946979 | Madani/2012 | 20 patients (stabilization splint group [n = 10] and gabapentin group [n = 10]) | Randomized Controlled Trial | | Key results | The 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) 24806220 | Fan/2014 | 6 randomized controlled trials that compared gabapentin 1800 mg/day to placebo for post-herpetic neuralgia | Meta-Analysis | | Key results | Gabapentin 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: |
09/16/2014 |
| 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
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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