Background <p>In pediatric patients, tooth extraction frequently results in unpleasant postoperative complications, including pain, inflammation, and bleeding. These painful experiences contribute to a child’s anxiety, which may reduce his compliance with subsequent dental treatments. This study aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) as an adjunctive treatment to enhance wound healing and manage post-extraction pain in children.</p> Materials and methods <p>This was a double-blind, split-mouth, randomized controlled clinical trial. A total of 18 children with a mean age of 6.5 years were included; each child had one primary molar bilaterally indicated for extraction. Eligible sides were randomly assigned to either the test group (<i>n</i> = 18) receiving PBMT using a diode laser of wavelength 660 nm, an output power of 100 mW, and an application duration of 60 s (total energy of 6 J), or to the control group (<i>n</i> = 18) (placebo treatment). A one-week interval was implemented between the extraction of the first and contralateral side as a washout period to optimize post-operative comfort and function. Both groups received post-extraction instructions. Primary outcomes included wound healing, assessed by Landry, Turnbull, and Howley wound healing index, and post-extraction pain, monitored over one week using a self-reported questionnaire assessing pain, discomfort, analgesic consumption, daily activities, and jaw-function impairment. Data were analyzed using the Wilcoxon signed-ranks test, and McNemar test, with significance defined as p &lt; 0.05.</p> Results <p>At day 7, the test group demonstrated significantly superior wound healing scores (Median: 5.00) compared to the placebo group (Median: 4.00) (<i>P</i> = 0.002*). Furthermore, PBMT significantly reduced the subjective feeling of discomfort on the first evening (<i>P</i> = 0.02*). Over the one-week follow-up, the test group showed no analgesic consumption compared to 33.3% in the placebo group (<i>P</i> = 0.03*). It also reported significantly less difficulty with chewing on the extraction site, chewing soft food, and difficulty with taking a big bite compared to the placebo group; with percentages (38.9% vs.88.9%, <i>P</i> = 0.004*), (0% vs.33.3%, <i>P</i> = 0.03*), and (33.3% vs.72.2%, <i>P</i> = 0.04*), respectively.</p> Conclusion <p>Photobiomodulation therapy is an effective adjunctive treatment following primary mandibular molar extraction. It significantly accelerates wound healing, reduces discomfort, and improves functional recovery by significantly reducing the need for post-operative analgesics.</p> Trial registration <p>This study was prospectively registered on March 6, 2025 (Trial registration number: <a href="https://clinicaltrials.gov/study/NCT07033403">NCT07033403</a>).</p>