Gabapentin for Children with Bruxism
Gabapentin is not recommended for treating bruxism in children, as there is no evidence supporting its efficacy for this indication, and other treatments with demonstrated effectiveness should be used instead.
Evidence Base for Bruxism Treatment in Children
The available evidence for pediatric bruxism treatment does not include gabapentin as a therapeutic option. A systematic review and meta-analysis of bruxism treatments in children identified only three medication classes with any evidence: hydroxyzine showed the strongest efficacy (OR 10.63), followed by flurazepam and Melissa officinalis, though the overall quality of evidence remains limited 1. Notably, gabapentin was not studied or mentioned in any pediatric bruxism trials 1, 2.
Why Gabapentin Is Not Appropriate
- No pediatric bruxism studies exist: Despite gabapentin's use in other pediatric conditions (neuropathic pain, certain neurological disorders), it has never been evaluated for bruxism in children 1, 2
- Adult bruxism literature excludes gabapentin: Comprehensive reviews of bruxism treatments in all age groups do not identify gabapentin as a treatment option, focusing instead on behavioral interventions, occlusal splints, clonazepam, clonidine, and botulinum toxin 3, 4
- Pregabalin (related compound) only studied in adults: A single case report showed pregabalin reduced awake bruxism in a 21-year-old woman with generalized anxiety disorder at 375 mg daily, but this was an adult with comorbid psychiatric conditions, not a child with primary bruxism 5
Recommended Treatment Approach for Pediatric Bruxism
First-line interventions should focus on non-pharmacologic approaches, as bruxism is not considered a disorder in otherwise healthy children 2:
- Counseling and behavioral modification: Address sleep hygiene, stress reduction, and relaxation techniques 3, 2
- Occlusal splints: Protect teeth from wear and reduce grinding noise with no reported adverse effects, making this the treatment of choice when intervention is needed 4
Pharmacologic options (when necessary for severe cases):
- Hydroxyzine: Demonstrated strongest efficacy in pediatric studies, though evidence quality remains limited 1
- Short-term benzodiazepines: Clonazepam showed large effect size in reducing bruxism activity in adults, but dependency risk limits long-term use and caution is needed in children 4
Critical Clinical Considerations
- Distinguish sleep vs. awake bruxism: Treatment approaches differ, and proper characterization is essential 3
- Rule out secondary causes: Medications, neurological disorders, or psychiatric conditions may drive bruxism and require different management 3
- Assess actual need for treatment: In otherwise healthy children, bruxism often does not require active intervention beyond monitoring and reassurance 2
- Avoid polypharmacy: The evidence base for any pharmacologic treatment in pediatric bruxism is weak, making empiric medication trials particularly problematic 1, 2
The lack of evidence for gabapentin in pediatric bruxism, combined with available alternatives that have at least some supporting data, makes gabapentin an inappropriate choice for this indication.