Ludwig’s Angina

What is Ludwig’s angina?

Ludwig’s angina (Ludwig angina) is a fast-growing cellulitis infection that affects the floor of your mouth. Swelling can spread quickly to your tongue and throat, making it hard for you to breathe.

This type of bacterial infection can occur after a mouth injury, but it usually happens because of an abscessed (infected) tooth.

Ludwig angina is a medical emergency and requires immediate medical care. Without treatment, it can be fatal. But early detection and quick medical care can get rid of the infection.

The condition gets its name from German physician Wilhelm Friedrich von Ludwig, who first described it in 1836. “Angina” describes any condition that causes severe pain in a specific area of your body.

What are the symptoms of Ludwig’s angina?

Ludwig’s angina symptoms can come on suddenly and may include:

• Difficulty breathing
• Difficulty swallowing
• Drooling
• Fever or chills
• Jaw pain or swelling
• Neck pain, swelling or discoloration
• Protruding or swollen tongue
• Slurred speech
• Tongue tenderness or pain under your tongue
• Toothache

Symptoms can get worse quickly. Prompt medical care is key.

Ludwig angina isn’t contagious. If you have it, you can’t pass it to someone else.

What causes Ludwig’s angina?

The most common cause of Ludwig angina is an abscessed lower molar tooth. Over 90% of cases start this way.

Other causes include:

• Injury inside your mouth, especially around the back of your lower jaw
• Oral surgery complications
• Pericoronitis (gum inflammation around a wisdom tooth)

Bacteria species that commonly cause Ludwig angina are Streptococcus, Staphylococcus and Bacteroides.

Risk factors

You have a higher risk of developing Ludwig angina if you have:

• A compromised immune system
• Alcohol use disorder
• Cavities
• Diabetes
• Malnutrition
• Oral cancer
• Poor oral hygiene

What are the complications of Ludwig’s angina?

The longer you go without treatment, the more likely it is that you’ll develop complications. They include:

• Asphyxiation (lack of oxygen)
• Aspiration pneumonia (lung infection)
• Blocked airway
• Mediastinitis (infection in your chest)
• Sepsis (life-threatening reaction to an infection)
• Septic shock (last stage of sepsis that involves dangerously low blood pressure)

How is Ludwig’s angina diagnosed?

Healthcare providers usually diagnose Ludwig angina during a physical exam. They’ll look for swelling around the front of your neck and underneath your jaw. They’ll also check for an enlarged tongue and swelling on the floor of your mouth.

Your healthcare provider may run additional tests like:

• Bacteria culture test. This can tell your provider whether the infection has spread to your bloodstream. They’ll need a small sample of your blood to run this test.
• CT scan. This imaging test can show your provider the severity of the infection. It can also help them detect abscesses. They’ll only do this test after they’ve treated any breathing issues.
• Ultrasound. This test can help your provider detect blood clots and pockets of infection. It can also determine whether the infection has spread to your bone.

How is Ludwig’s angina treated?

Ludwig angina treatments include:

• Opening your airway. The main goal is to open your airway and give you oxygen so you can breathe normally again. Healthcare providers can usually do this by placing a thin, flexible tube (nasal cannula) into your nose and down your throat.
• Medications. Once your airway is open, your provider will likely give you antibiotics through an IV line. They may also give you corticosteroids to reduce swelling.
• Surgery. In severe cases, healthcare providers may surgically drain the infection. If an infected tooth caused Ludwig angina, you may need to remove it.

Can Ludwig’s angina be prevented?

You can’t always prevent Ludwig angina. But you can reduce your risk by practicing good oral hygiene and seeing your dentist for regular checkups and cleanings. It’s important to treat dental infections promptly since they’re the most common cause of Ludwig angina.

What’s the outlook for people with Ludwig’s angina?

Most people survive Ludwig’s angina today, thanks to the invention of antibiotics. But early detection and treatment are essential. The sooner you get treatment, the better your outlook.

Fatalities from Ludwig angina are rare, but they can happen. About 8% of people who develop the infection die from the swelling and lack of oxygen.

When should I see my healthcare provider?

Call 911 or go to your local emergency room if you have:

• Difficulty breathing or swallowing
• Severe pain that’s getting worse
• Swelling around your neck or under your jaw

What questions should I ask my doctor?

If you’ve received treatment for Ludwig’s angina, here are some questions you might want to ask your healthcare provider:

• Why did I get Ludwig’s angina?
• How can I lower my risk of infection?
• How often should I get dental checkups?