Parental expectations and nocebo by proxy effects in adolescent orthodontic treatment outcomes

This study examines the nocebo effect in orthodontics by assessing how parental orthodontic experiences and attitudes toward dental care influence children's pain and discomfort at treatment onset. Consecutive orthodontic patients aged 12-18 years were included in this prospective observational cohort study. Parents' prior orthodontic experiences, perceptions of dental care, and pain expectations were assessed by questionnaire. Children completed the Pain Catastrophizing Scale (PCS) and the Spielberger State Trait Anxiety Inventory for Children (STAIC) before fixed appliance bonding. Follow-up questionnaires 3-5 days post-bonding assessed pain, dysfunction, medication use, and oral health impact (OHIP-14). Non-parametric tests and regression analyses were used to assess associations between parental expectations and patient-reported outcomes. Seventy patients (mean age 14.1 ± 1.7 years; 51.3% females) were included. Greater pain medication use was reported among patients whose parents had prior orthodontic experience (p = 0.038). Parental associations of orthodontic care with pain were linked to higher patient anxiety and pain catastrophizing. Regression analyses confirmed associations between parental expectations and patient orofacial dysfunction, anxiety, pain catastrophizing, and oral health impact. The study indicates a proxy nocebo effect in orthodontics, where parental experiences and perceptions influence children's pain during treatment. Addressing parental perceptions may help reduce this effect and improve treatment experiences for children and adolescents.