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Key takeaways
Gabapentin is a prescription drug intended to treat seizures and nerve pain. It is commonly used off-label for postoperative dental pain.
Gabapentin‘s mechanism of action is complex, but it ultimately relieves pain by reducing the pain signals sent from nerves to the brain.
Gabapentin reduces pain after dental procedures but is not the only pain reliever for tooth pain. Ibuprofen, acetaminophen, or one of those drugs in combination with gabapentin may be more effective than gabapentin alone.
Gabapentin is generally safe, but it does have some potentially serious side effects, such as confusion, which can increase the risk of falling.
It’s essential to consult a healthcare provider before taking this medication for a toothache.
Gabapentin is a generic prescription anticonvulsant approved by the U.S. Food and Drug Administration (FDA) to treat epilepsy and postherpetic neuralgia, pain caused by shingles-related nerve damage. It’s also sold under the brand names Neurontin and Gralise. Because of its effectiveness in relieving nerve pain, some dentistry clinicians prescribe gabapentin for tooth pain.
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Is gabapentin good for tooth pain?
“Gabapentin is not FDA-approved for the treatment of tooth pain. But, gabapentin may be used off-label for other conditions, such as nerve pain,” says Joanne Nguyen, Pharm.D., BCACP, NCTTP, a Georgia-based clinical pharmacy practitioner.
Though gabapantin’s mechanism of action is still not fully understood, according to Nguyen, the beneficial effect is clear: It decreases the intensity of nerve pain.
A 2010 review of clinical trials found that a single dose of gabapentin was more effective than placebo pills at reducing surgical pain, including dental procedures. However, it was not more effective than standard pain relievers.
A 2022 study of 90 patients getting root canals found that pregabalin, a different prescription drug, was more effective at relieving pain than gabapentin. At 72 hours after the procedure, patients who received pregabalin reported 92.1% pain relief, while patients who received gabapentin reported 87.6% pain relief.
In many cases, gabapentin is prescribed together with over-the-counter (OTC) drugs such as acetaminophen or ibuprofen. Some experts suggest that gabapentin combined with OTC pain relievers may be as effective and safer than the use of opioid medications for relieving dental pain.
How does gabapentin work to provide toothache relief?
“It’s still unclear how gabapentin works. For postherpetic neuralgia, pain associated with shingles, gabapentin seems to decrease the release of certain pain signals in the brain,” says Dr. Nguyen. In other words, gabapentin may reduce the sensation of dental pain — the ache of your nerve-related toothache — but it’s not fixing the root cause.
“Gabapentin doesn’t heal the nerves. It mainly helps to mask the pain,” confirms Aaron Bulleigh, DDS, a doctor of dental surgery at Desert Springs Dental Care. “It makes the pain more manageable, like turning down the volume on a loudspeaker, but it doesn’t fix the underlying problem with the nerves.”
How long does gabapentin take to work for tooth pain?
There is no established time frame for how long it would take for gabapentin to begin to relieve a toothache. Dr. Nguyen says a person’s age, other medications, and medical conditions can all affect how long it takes for gabapentin to kick in.
That said, a 2012 study on gabapentin for shingles-related nerve pain found that patients have the highest blood concentration of gabapentin two to three hours after taking it by mouth.
Ultimately, it may take a few hours for gabapentin to have an analgesic effect. Even then, this drug will only relieve pain caused by nerve damage. Anyone interested in taking gabapentin for a toothache should consult a healthcare provider or dentist about the best pain reliever based on the cause of their dental pain.
Potential side effects of gabapentin
Gabapentin is considered generally safe, but it’s still important to be aware of the side effects of this drug.
The most common side effects reported in clinical trials were dizziness, drowsiness, and swelling.
Gabapentin can also cause serious side effects, including:
- Depression or suicidal thoughts
- Severe muscle pains
- Loss of coordination
- Trouble breathing
- Confusion, slurred speech, or memory problems
- Severe rash
- Withdrawal seizures, if stopped suddenly
- DRESS syndrome: Fever, skin rash, swollen neck glands, change in how much or how often you urinate, or bloody or cloudy urine
Contact your healthcare provider right away if you experience any of the above serious side effects after taking gabapentin.
Why would a dentist prescribe gabapentin?
“A dentist might prescribe gabapentin if you have nerve pain in your mouth or face, such as from trigeminal neuralgia or after a dental surgery,” says Dr. Bulleigh. “Gabapentin helps to calm the nerves and reduce the pain signals they send to your brain, making you more comfortable.”
There are several situations in which a dental professional may prescribe gabapentin.
These include:
- Pain management after tooth extractions
- Preoperative pain prevention before dental surgery
- Postoperative pain control (after a root canal or other dental surgery)
- Chronic pain from orofacial nerve damage
- Unexplained orofacial pain
- Some instances of bruxism (teeth grinding)
Gabapentin can be a strong painkiller in certain situations, but it depends on the type of pain. Only a healthcare provider who understands the cause of your tooth pain can decide if gabapentin is the best painkiller for you.
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Alternatives to gabapentin for tooth pain
Gabapentin is not the only possible treatment for tooth pain. Depending on your condition, other prescription medications, and the cause of your toothache, your dentist or other healthcare provider may not recommend this drug.
Dr. Bulleigh says OTC analgesics can be good alternatives to gabapentin for tooth pain. “They reduce inflammation and provide effective pain relief,” he explains.
OTC painkillers include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and Advil
- Acetaminophen (Tylenol)
- Topical anesthetics (“Lidocaine gels can be directly applied to the painful area, providing quick, localized pain relief,” states Dr. Bulleigh.)
Dr. Bulleigh says a dentist may also recommend an opioid for tooth pain. However, while opioids offer potent pain relief, there is a substantial risk of side effects and the potential for opioid dependence, addiction, and overdose. Anyone with a history of prescription drug misuse or addiction should tell their oral health provider, as non-opioid pain medications may be a better solution for pain relief. In the end, says Dr. Nguyen, anyone experiencing chronic or severe tooth pain should seek medical advice from a healthcare provider.
Sources
- Single dose oral gabapentin for established acute postoperative pain in adults, Cochrane Library (2010)
- Comparison of pretreatment gabapentin and pregabalin to control postoperative endodontic pain – a double-blind, randomized clinical trial, Journal of Dental Anesthesia and Pain Medicine (2022)
- Comparison of analgesic prescriptions for dental pain and patient pain outcomes before vs after an opioid reduction initiative, JAMA Network Open (2022)
- Gabapentin for once-daily treatment of postherpetic neuralgia: A review, Clinical Interventions in Aging (2012)
- Gabapentin tablet, DailyMed (2012)
- Antidepressant-induced bruxism successfully treated with gabapentin, The Journal of the American Dental Association (1999)
