Further evidence of a prolonged hypotensive and a bradycardic effect after mandibular extension in normal volunteers.

Abstract

We previously reported that in normotensive humans submaximal mouth opening (mandibular extension) obtained by an ad hoc dilator (spring device), associated with partial masticatory movements and prolonged for 10 minutes is followed by a long-lasting reduction of blood pressure (BP) and heart rate (HR). Similar results were obtained by us in anesthetized rats. A recent independent study failed to confirm the results in the normotensive human. We reassessed, in 25 normotensive volunteers, the effects on BP and HR of mandibular extension obtained by the spring device associated with partial masticatory movements compared to a control procedure, consisting in keeping a tongue depressor between the incisor teeth. Both procedures were applied for 10 minutes and systolic BP (SBP), diastolic BP (DBP) and HR were measured every 10 minutes by an automatic recorder, for 30 minutes before and 120 minutes after the procedures in seated subjects watching nature documentary films on laptop screen.Baseline levels (mean of the last 3 measurements before procedure) did not significantly differ between the experimental and control sessions. Two way repeated measures ANOVA on absolute (recorded) values did not reveal a significant main effect of treatment for SBP, DBP and HR, but a significant main effect of time (P<0.001) for BP and HR. In addition, a significant interaction of time and treatment was found for SBP (P<0.001) and DBP (P=0.005), but not for HR. In addition, two way repeated measures ANOVA was done on changes from baseline obtaining a significant main effect of treatment (P<0.001) and time (P<0.001) and a significant interaction of time and treatment for SBP (P<0.001) and DBP (P<0.01). Post-hoc comparisons revealed significantly lower values for SBP and DBP in experimental compared to control values at almost all times and this decrement was by about 5 mmHg. Furthermore, for both absolute values and changes from baseline, the interaction effect was, for BP, of a qualitative type as indicated by an opposite effect in the time-course between control and experimental sessions. This study thus provides confirmatory evidence that submaximal mouth opening for a relatively brief time is followed by prolonged albeit small reductions of BP in normotensive human volunteers.