Ludwig's Angina

What is Ludwig’s angina?

Ludwig’s angina is a bacterial infection (cellulitis) that affects your neck and the floor of your mouth. It is not contagious. It typically starts from a tooth infection (abscessed tooth). This rare type of cellulitis can spread rapidly, causing life-threatening swelling that can affect your ability to breathe.

What are other names for Ludwig’s angina?

The condition gets its name from German physician Wilhelm Friedrich von Ludwig who first described it in 1836. It goes by both Ludwig’s angina and Ludgwig angina. Healthcare providers also call it “sublingual space infection” and “submandibular space infection.” These terms all refer to the same condition.

What parts of your body does Ludwig’s angina affect?

The infection affects the:

• Sublingual space under your tongue.
• Submandibular space beneath your lower jaw (mandible).
• Submental triangle, a space in the front part of your neck below your chin.

What causes Ludwig’s angina?

An abscessed tooth (tooth infection) causes Ludwig’s angina. In 9 of 10 cases, the infection starts in the second or third molar in your lower jaw.

Ludwig’s angina is a rare form of cellulitis. This bacterial infection affects your skin and underlying tissues. Group A streptococcal infections and staph infections can cause cellulitis.

When you have Ludwig’s angina, the cellulitis infection spreads quickly in your mouth to your tongue and throat area. Swelling (edema) occurs, which can make it difficult to breathe.

Who is at risk for Ludwig’s angina?

You may be more prone to Ludwig’s angina if you have:

• A broken jaw (facial fracture).
• Cavities, a fractured tooth (cracked tooth) or a tooth extraction.
• Diabetes.
• Malnutrition.
• Oral cancer.
• Poor oral hygiene.
• Substance use disorder.
• Tongue piercings.
• Weakened immune system.

What are the symptoms of Ludwig’s angina?

Symptoms of Ludwig’s angina include:

• Difficulty speaking.
• Fever or chills.
• Jaw pain.
• Neck pain, swelling or redness.
• Protruding or swollen tongue.
• Swollen cheeks and jaw.
• Tongue tenderness or pain under the tongue.
• Toothache.

What are the complications of Ludwig’s angina?

An untreated infection can lead to life-threatening sepsis. As swelling worsens and breathing becomes more difficult, these complications may also occur:

• Confusion (delirium).
• Extreme fatigue.
• Difficulty swallowing (dysphagia), which causes drooling.
• Raspy breathing (stridor).

These symptoms indicate a medical emergency, requiring immediate care. Call 911.

How is Ludwig’s angina diagnosed?

Your healthcare provider can diagnose Ludwig’s angina based on your symptoms. You may also get a CT scan.

For initial symptoms like toothache, you may see a dentist. In an emergency situation, you need to go to a hospital emergency department.

How do providers treat Ludwig’s angina?

When detected early, IV antibiotics can clear up the infection. When swelling becomes life-threatening and affects your ability to breathe, you’ll need:

• Tracheostomy to aid breathing.
• IV antibiotics followed by oral antibiotics.
• Surgery to pull the tooth and drain the infection.

Can you prevent Ludwig’s angina?

Good oral hygiene and regular dental check-ups can prevent the tooth infections that cause Ludwig’s angina. Don’t delay in seeking treatment for toothaches, mouth sores and other oral problems.

What is the outlook for someone with Ludwig’s angina?

With fast treatments of antibiotics and surgery, most people survive Ludwig’s angina. About 8% of people who develop the infection die from the swelling and lack of oxygen (asphyxiation).

When should I call the doctor?

If you have trouble breathing or swallowing, call 911 to get immediate medical care. You should call your healthcare provider if you have:

• Signs of infection like fever and chills.
• Swelling or pain in your neck, cheek or jaws.
• Tender tongue.
• Toothache.

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused Ludwig’s angina?
• What treatments do I need?
• What steps can I take to prevent infections?
• How often should I get dental check-ups?
• Should I look for signs of complications?

A note from Cleveland Clinic

Bacteria from a tooth infection can spread quickly when you have Ludwig’s angina. Proper brushing and flossing can help prevent this rare type of cellulitis. You should see your healthcare provider anytime you have a toothache, oral injury or facial swelling. If you find yourself struggling to breathe or swallow, seek medical attention immediately. With antibiotics and surgery to drain the abscess, most people recover. Without fast treatment, Ludwig’s angina can be fatal.