Extracorporeal shock wave therapy for temporomandibular disorders: efficacy on pain, maximal mouth opening, and...

Temporomandibular disorders (TMD) are common heterogeneous conditions characterized by chronic orofacial pain, limited maximal mouth opening, and impaired masticatory function. Extracorporeal shock wave therapy (ESWT) is a well-established non-invasive rehabilitation intervention, but its efficacy in improving pain, maximal mouth opening (MMO), and dysfunction index (DI) remains controversial. This study aims to evaluate the therapeutic effectiveness of ESWT in patients with TMD through a systematic review and meta-analysis.

We conducted a systematic search in PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, and VIP Database, with the search period ending in December 2025. Randomized controlled trials (RCTs) comparing ESWT with rehabilitation interventions, sham therapy, medication, or no treatment were included. The main outcome measures were pain intensity (VAS), maximal mouth opening (MMO), and dysfunction index (DI).

A total of 18 studies involving 1,150 participants were included. ESWT showed a significant therapeutic effect on pain reduction (MD = -1.28; 95% CI: [-1.96, -0.61], Z = 3.75, P < 0.00001, I² = 95%). ESWT significantly increased maximal mouth opening (MD = 3.76; 95% CI: [1.52, 5.99], Z = 3.29, P = 0.0010, I² = 97%). No significant improvement was observed in dysfunction index (MD = -0.05; 95% CI: [-0.13, 0.03], Z = 1.24, P = 0.22, I² = 99%). Through subgroup analysis based on pain assessment, we further explored the sources of heterogeneity related to shock number, treatment period, and gender.

The results of this meta-analysis indicate that ESWT has a significant positive effect in alleviating pain and improving maximal mouth opening in patients with TMD. However, because of the existence of heterogeneity and potential risk factors, the therapeutic effect of ESWT needs to be interpreted with caution.