Failure in evoking the trigeminal cardiac reflex by mandibular stretching in healthy volunteers

Carlo De Innocentiis, Cristiano Giovannni Caputi, Filomena Pinto, Stefania Quintiliani, Armando Meccariello, Giulia Renda, Marta Di Nicola, Raffaele De Caterina, Michele D'Attilio


Stimulation of trigeminal sensory afferences has been reported to evoke hypotension and bradycardia, a phenomenon known as the trigeminal cardiac reflex. We attempted to evoke such a reflex through cycles of alternate mandibular stretching in healthy volunteers, as previously reported, for its possible therapeutic exploitation. In Phase 1 of the study, 10 healthy volunteers [5 male, 5 female, age (mean ± SD) 27±2 years)] underwent 2 randomized sessions of automated monitoring, every 6 minutes, of systolic blood pressure (SBP), diastolic (D) BP, and heart rate (HR), with a one-week interval, either with mandibular stretching (12 minutes with a spring device fitted in the mouth), or nothing (control). Observation was prolonged for 180 minute after the end of the stretching. In Phase 2, 7 other volunteers (4 male and 3 female, age 24±1.3 years) repeated the protocol with a sampling interval of 2 minutes until the end of stretching. Baseline levels of SBP, DBP and HR were similar in the test and control sessions. There was a progressive fall of BP and HR as a function of time during the test session. With stretching: SBP changed from 119.2±10.1 to 118.1±10.1 to 115.8±10.5 mmHg, at baseline, end of stretching and 180 minutes after, respectively, P<0.001 at ANOVA for time effect). However. Similar changes occurred in the control group: from 120.7±12.0 to 120.8±12.0 to 115.4±3.6 mmHg at the same times, P=0.822 for group effect). In Phase 2, again we observed no significant changes for any of the parameters investigated as a function of treatment. Despite attempts at maximum standardization of study condition and the use of operator-independent BP and HR measurements, we could not detect significant BP or HR effects of repeated mandibular stretching.


Trigeminal cardiac reflex; gnawing; mandibular stretching; blood pressure, heart rate.

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