Arakeri’s Reflex: an Alternative Pathway for Dento-Cardiac Reflex Mediated Syncope

Introduction: Dentocardiac reflex, a variant of trigeminocardiac reflex elicited specifically during tooth extraction procedures in den-tal/maxillofacial surgery and is believed to cause syncope with an afferent link mediated by posterior superior alveolar nerve. Another variant of trigeminocardiac reflex which is also of interest to the oral and maxillofacial surgeon is oculocardiac reflex which can be triggered by direct or indirect manipulation of eye globe or muscles around it.The hypothesis: Excessive or injudicious pressure or manipulations around the maxillary first molars during extraction procedure are as-sociated with maximum incidence of bradycardia and hypotension than around incisor/ canine/ third molars. This is because; the pressure on eye globe and ophthalmic rectus muscle is maximum during extraction of first molar than incisor/canine and third molars. This observation led us to postulate an alternative pathway for dentocardiac reflex mediated syncope which may possibly justify the maxillary first molar region as a prone factor for the trigger. Evaluation of the hypothesis: Present hypothesis may not confer the specific factor responsible for switch in autonomic response in syncope origin during the tooth extraction procedure, but may provide a clue to where we should be looking.