What is Ludwig’s angina?
Ludwig’s angina is a rare skin infection that occurs on the
floor of the mouth, underneath the tongue. This bacterial infection often occurs
after a tooth abscess, which is a collection of pus in the center of a tooth.
It can also follow other mouth infections or injuries. This infection is more
common in adults than children. Usually, people who get prompt treatment
Symptoms of Ludwig’s angina
The symptoms include swelling of
the tongue, neck pain, and breathing problems.
Ludwig’s angina often follows a tooth infection or other infection
or injury in the mouth. The symptoms include:
- pain or tenderness in the floor of your mouth, which
is underneath your tongue
- difficulty swallowing
- problems with speech
- neck pain
- swelling of the neck
- redness on the neck
- an earache
- tongue swelling that causes your tongue to push
against your palate
- a fever
Call your doctor if
you have symptoms of Ludwig’s angina. As the infection progresses, you
may also experience trouble breathing and chest pain. It may cause serious
complications, such as airway blockage or sepsis, which is a severe
inflammatory response to bacteria. These complications can be life-threatening.
You need immediate
medical attention if you have a blocked airway. You should go to the emergency
room or call 911 if this occurs.
Causes of Ludwig’s angina
Ludwig’s angina is a bacterial infection. The bacteria Streptococcus and Staphylococcus
are common causes. It often
follows a mouth injury or infection, such as a tooth abscess. The following may
also contribute to developing Ludwig’s angina:
- poor dental hygiene
- trauma or lacerations in the mouth
- a recent tooth extraction
Diagnosing Ludwig’s angina
Your doctor may diagnose this condition by performing a
physical exam, fluid cultures, and imaging tests.
A doctor’s observations of the following symptoms are
usually the basis for diagnosis of Ludwig’s angina:
- Your head, neck, and tongue may appear red and
- You may have swelling that reaches to the floor
of your mouth.
- Your tongue may have extreme swelling.
- Your tongue may be out of place.
If your doctor can’t diagnose you with just a visual
examination, they may use other tests. Contrast-enhanced MRI or CT images can
confirm swelling on the floor of the mouth. Your doctor can also test fluid
cultures from the affected area to identify the specific bacterium that’s
causing the infection.
Treatment for Ludwig’s angina
Clear the airway
If the swelling is interfering with your breathing, the
first goal of treatment is to clear your airway. Your doctor may insert a
breathing tube through your nose or mouth and into your lungs. In some cases,
they need to create an opening through your neck into your windpipe. This procedure
is called a tracheotomy. Doctors perform it in emergency situations.
Drain excess fluids
Ludwig’s angina and deep neck infections are serious and can
cause edema, distortion, and obstruction of the airway.
Surgery is sometimes necessary to drain excess fluids that are causing
swelling in the oral cavity.
Fight the infection
It’s likely you’ll need antibiotics through your vein until
the symptoms go away. Afterward, you’ll then continue antibiotics by mouth
until tests show that the bacteria are gone. You’ll need to get treatment for
any additional dental infections as well.
Get further treatment
You might need further dental treatment if a tooth infection
caused the Ludwig’s angina. If you continue to have problems with swelling, you
may need surgery to drain the fluids that are causing the area to swell.
What is the long-term outlook?
Your outlook depends on the severity of the infection and
how quickly you seek treatment. Delayed treatment increases your risk for
potentially life-threatening complications, such as:
- a blocked airway
- sepsis, which is a severe reaction to bacteria
or other germs
- septic shock, which is an infection that leads
to dangerously low blood pressure
With proper treatment, most people make a full recovery.
How to prevent Ludwig’s angina
You can decrease your risk of developing Ludwig’s angina by:
- practicing good oral hygiene
- having regular dental checkups
- seeking prompt treatment for tooth and mouth
If you’re planning on getting a tongue piercing, make sure
it’s with a professional using clean, sterile tools. See your doctor
immediately if you have excess bleeding or the swelling isn’t going down.
You should brush your teeth twice every day and use
mouthwash with antiseptic liquid once per day. Never ignore any pain in your gums
or teeth. You should see your dentist if you notice a foul smell coming from
your mouth or if you’re bleeding from your tongue, gums, or teeth.
Pay close attention to any problems in your mouth area. See
your doctor immediately if you have a compromised immune system or have
recently had some sort of trauma in your mouth, including a tongue piercing. If
you have a mouth injury, make sure to see your doctor so that they can ensure it’s