Is there an increased incidence of tooth decay in patients taking gabapentin (Neurontin)?

Gabapentin and Tooth Decay: No Direct Association

There is no established direct association between gabapentin (Neurontin) and increased incidence of tooth decay. Based on current guidelines and available evidence, gabapentin is not known to directly cause dental caries 1.

Potential Indirect Effects on Oral Health

While gabapentin itself is not directly linked to tooth decay, there are several indirect mechanisms that could potentially impact oral health:

1. Xerostomia (Dry Mouth)

   • Many medications, including some anticonvulsants, can cause dry mouth as a side effect
   • Reduced saliva flow increases risk of dental caries due to decreased natural cleansing and buffering capacity
   • However, gabapentin is not specifically highlighted in guidelines as a major cause of medication-induced xerostomia

2. Oral Dysesthesia Management

   • Gabapentin is actually recommended for treatment of oral dysesthesia (burning mouth sensation) in moderate to severe cases 1
   • The NCCN guidelines recommend gabapentin along with high potency topical steroids or viscous lidocaine for managing oral dysesthesia

3. Medication-Related Considerations

   • Long-term use of gabapentin (12+ months) is common, with approximately 50% of patients receiving continuous treatment 1
   • Patients on long-term gabapentin should be monitored for any changes in oral health

Risk Factors to Consider

Certain patient populations may require additional monitoring:

• Patients with immunotherapy-related toxicities who are prescribed gabapentin for oral dysesthesia 1
• Patients with renal disease on gabapentin for uraemic pruritus 1
• Patients with chronic pain conditions who may be on multiple medications 1

Recommendations for Dental Management

For patients taking gabapentin:

• Regular dental check-ups are recommended to monitor oral health
• Proper oral hygiene practices should be emphasized
• Assess for xerostomia and recommend appropriate management if present
• Consider potential drug interactions with other medications that may affect oral health

Important Considerations

• Patients with severe sicca syndrome (dry mouth) can lose their teeth due to the severity of dry mouth and loss of salivary protection 1, but gabapentin is not specifically identified as a causative agent
• Patients taking gabapentin for neuropathic pain should be monitored for potential abuse, as there has been a rise in the nonmedical use of gabapentin 2
• Some medications with acidic properties can cause dental erosion 3, but gabapentin is not identified among these

In conclusion, while monitoring oral health is important for all patients on chronic medications, current evidence does not support a direct causal relationship between gabapentin use and increased tooth decay.