Alpaca Zevallos É.A. et al. - Photobiomodulation, Corticosteroids, and NSAIDs After Wisdom Tooth Surgery: A Systematic Review of Randomized Trials

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This systematic review of 36 randomized trials (1,838 participants) compares corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and photobiomodulation following wisdom tooth extraction. The results for photobiomodulation are heterogeneous and depend on the protocol, and the evidence does not allow for a ranking of the three approaches.

What this study measured

Surgical extraction of a wisdom tooth is often accompanied by pain, swelling (edema), and difficulty opening the mouth (trismus). Corticosteroids, NSAIDs, and photobiomodulation are used to minimize these side effects, but they are rarely compared with one another. The team led by Érick Andres Alpaca Zevallos at the University of Santa Maria in Peru sought to summarize the efficacy and safety of these three approaches in randomized trials.

The review follows the PRISMA 2020 guidelines and has been registered in PROSPERO. Five databases were searched (PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar), with no language or date restrictions. Trials had to evaluate at least one of the interventions and report on pain, swelling, trismus, the use of rescue medication, or adverse effects. The risk of bias was assessed using the Cochrane RoB 2 tool.

Key Findings

Thirty-six randomized trials, involving 1,838 participants, were included.

Breakdown: 13 trials focused primarily on corticosteroids, 11 on NSAIDs, 7 on photobiomodulation, and 5 directly compared treatments or combinations
Risk of bias: 27 low-risk trials, 7 with reservations, 2 high-risk trials
Corticosteroids: often associated with a reduction in edema and trismus
NSAIDs: more consistent effects on pain than on edema or trismus
Photobiomodulation: Mixed Results, Depending on the Protocol

Few trials have directly compared the different treatment classes. The heterogeneity was too great for a valid meta-analysis or indirect comparison.

How photobiomodulation works for this indication

The abstract does not describe a specific mechanism. Generally speaking, it is proposed that red and near-infrared light may modulate tissue inflammation following a procedure. This hypothesis is not tested in the review, which compares clinical effects.

Above all, the authors emphasize that the results vary depending on the photobiomodulation protocol used. This suggests that treatment parameters matter, but the review does not allow us to identify one protocol as more effective than another.

Limits You Should Know

This is a mixed review: only 7 of the 36 trials focus primarily on photobiomodulation, and the review’s findings cannot be attributed solely to light. No quantitative synthesis is provided for photobiomodulation, as the trials are too diverse to be grouped together.

Protocols, outcome measures, and follow-up periods vary widely. Very few trials directly compare photobiomodulation with corticosteroids or NSAIDs, so no reliable hierarchy can be established. The summary also does not report a level of certainty according to the GRADE approach.

What This Means in Practice

For a patient who needs to have a wisdom tooth removed, this review indicates that corticosteroids, NSAIDs, and photobiomodulation may improve various outcomes, though none has been proven to be superior to the others. It does not provide a basis for choosing a treatment.

The decision is up to the dentist or oral surgeon. Photobiomodulation is not a substitute for prescribed medications, and no treatment should be discontinued or modified without professional advice.

Frequently Asked Questions

Does photobiomodulation reduce pain after wisdom tooth extraction?

The results reported for photobiomodulation are inconsistent and depend on the protocol. In this review, NSAIDs show more consistent effects on pain.

Is photobiomodulation better than corticosteroids?

The review does not allow us to draw this conclusion: few studies have directly compared the treatments, and the authors conclude that there is no established hierarchy among the approaches.

Why do the results vary so much?

The studies differ in their protocols, outcome measures, and follow-up periods. The authors call for direct comparative trials with standardized criteria and protocols.

Reference

Alpaca Zevallos EA, Nogueira LLT, Ferreira AJ, et al. Clinical Effects of Photobiomodulation, Corticosteroids, and Nonsteroidal Anti-Inflammatory Drugs Following Third Molar Surgery: A Systematic Review of Randomized Clinical Trials. International Journal of Dentistry, 2026. PMID 42928805. DOI 10.1155/ijod/5965550. View the study on PubMed

This summary is provided for informational purposes only and does not constitute medical advice. Photobiomodulation is not a substitute for prescribed treatment. Consult a healthcare professional.