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Oral Health
Published on
June 27, 2026

Zhang L. et al. - Photobiomodulation and Myogenic Temporomandibular Disorders: A Network Meta-Analysis

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In a network meta-analysis of 41 randomized trials, photobiomodulation ranked highest among non-pharmacological treatments for reducing short-term pain associated with myogenic temporomandibular disorders in adults. Manual therapy remained the highest-ranked treatment for improving maximum mouth opening.

What this study measured

Muscle-related temporomandibular disorders, or myogenic TMDs, are characterized by pain in the masticatory muscles and limited jaw movement. Lei Zhang’s team compared ten non-pharmacological approaches using a network meta-analysis, a method that indirectly compares treatments that have never been tested against one another: photobiomodulation, manual therapy, exercises, occlusal splints, acupuncture, electrotherapy, combination therapies, cognitive-behavioral therapy, central neuromodulation, and shock wave therapy. Five databases, including MEDLINE, Embase, and Cochrane CENTRAL, were searched through October 31, 2025, with no language restrictions, and only randomized trials conducted in adults aged 18 years and older were included. The primary outcomes were pain and maximum mouth opening, assessed in the short term. A total of 41 trials and 2,021 participants were included; the protocol was registered on PROSPERO under number CRD420261278458.

Key Findings

For pain, photobiomodulation ranks first in the probabilistic ranking; for jaw mobility, the hierarchy is reversed in favor of manual therapy. The SUCRA score indicates the probability of a good ranking, not direct superiority.

  • Pain: Photobiomodulation ranked first, SUCRA 88.9%
  • Superior to cognitive-behavioral therapy (SMD -2.00; 95% CI -2.99 to -1.00) and to electrotherapy (SMD -1.64; 95% CI -2.55 to -0.73)
  • Superior to conventional care (SMD -1.49; 95% CI -2.07 to -0.91), occlusal splints (SMD -1.43; 95% CI -2.29 to -0.56), and acupuncture (SMD -1.07; 95% CI -1.93 to -0.21)
  • Manual therapy: SUCRA 79.9% for pain; combined therapies: 72.5%
  • Maximum mouth opening (31 studies, 1,463 participants): manual therapy as the first-line treatment, SUCRA 92.9%, superior to photobiomodulation (SMD 2.23; 95% CI 0.19 to 4.28)

How photobiomodulation works for this indication

The proposed mechanism remains hypothetical. Red and near-infrared light is thought to be absorbed by cytochrome c oxidase, a mitochondrial enzyme, which would promote a transient increase in ATP production and a modulation of oxidative stress. In a painful masticatory muscle, these effects could be accompanied by a decrease in inflammatory mediators and reduced sensitization of nociceptive nerve endings, which would explain a reduction in perceived pain without any mechanical action on the joint. None of these effects were measured in the included trials: the hypothesis remains plausible but unproven.

Limits You Should Know

The risk of bias was assessed using the Cochrane RoB 2.0 tool, and the trials are of varying quality. A statistical inconsistency was observed regarding pain in the comparison of electrotherapy versus manual therapy, which weakens part of the network. Sample sizes are modest, with approximately fifty participants per trial. All outcomes are short-term: the durability of the effects has not been documented. Finally, a high SUCRA score indicates a probable position within a network of comparisons—some of which are indirect—rather than established superiority.

What This Means in Practice

The authors suggest choosing the treatment modality based on the primary objective: photobiomodulation when pain is the main concern, and manual therapy when limited mouth opening is the primary issue. This interpretation does not replace an examination by a dentist, who must first rule out an articular cause. The abstract does not specify the wavelengths, doses, or number of sessions used: these parameters cannot be deduced from the published data.

Frequently Asked Questions

Does photobiomodulation relieve jaw pain?

In this meta-analysis of 41 randomized trials, it had the most favorable pain profile among ten non-pharmacological approaches (SUCRA 88.9%). Measurements were taken immediately after treatment: there is no evidence to suggest that the effect persists for several months.

Which is better for temporomandibular joint disorder: laser therapy or physical therapy?

The two approaches have different goals here: photobiomodulation is more effective for pain, while manual therapy is more effective for improving mouth opening. The choice depends on the predominant symptom, and both can be considered together with a healthcare professional.

How many people were included in the study?

41 trials and 2,021 adults for pain, 31 trials and 1,463 participants for mouth opening—small sample sizes given the number of treatments compared.

Reference

Zhang L, Liu M, Li X, Zhao C. Comparative effectiveness of nonpharmacological therapies for myogenic temporomandibular disorders in adults: a network meta-analysis of randomized trials. BMC Oral Health, 2026. PMID 42365270. 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.