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What Is Ludwig’s Angina?

Medically Reviewed by Dan Brennan, MD on April 22, 2021

Ludwig’s angina is a rare but serious bacterial skin infection that affects your mouth, neck, and jaw. Considered a type of cellulitis, Ludwig’s angina spreads rapidly to infect the soft tissues underneath your tongue.

This serious condition is more common in adults than children. The infection causes the tongue to rise as the infection spreads and may result in breathing difficulties or blockage if left untreated.

What Causes Ludwig’s Angina?

Bacteria from dental infections or poor oral hygiene are the cause of this skin infection. You can develop Ludwig’s angina if you get a cavity or tooth abscess – often in your second and third molars – or you get periodontitis or gingivitis.

Streptococcal and staphylococcal bacteria are the most common types of bacteria that lead to Ludwig’s angina, especially Streptococcus viridans, Staphylococcus epidermis, and Staphylococcus aureus.

What Else Increases Your Risk for Ludwig’s Angina?

You might be at risk for developing Ludwig’s angina if you have any of the following:

  • Jawbone fracture
  • Tongue piercing
  • Jawbone infection
  • Mouth injury
  • Tonsil abscess
  • Salivary gland infection
  • Thyroglossal cyst

Oral hygiene is important for many reasons, including reducing your risk for serious conditions like Ludwig’s angina.

What Are the Signs and Symptoms?

You often experience fever, mouth pain, neck swelling, and a swollen tongue when you have Ludwig’s angina.

Other symptoms you may experience include:

Severe cases of Ludwig’s angina, or when left untreated, can cause symptoms like:

How Do You Diagnose Ludwig’s Angina?

Your doctor will give you a physical examination to check your neck, jaw, lymph nodes, the inside of your mouth, your chest, and lungs. In most cases, this physical exam shows enough symptoms to diagnose Ludwig’s angina.

If your doctor can’t make the diagnosis, they may order blood and salivary cultures to check for bacteria. They may also order a computed tomography (CT) or magnetic resonance imaging (MRI) scan using contrast dye. These procedures scan your mouth, neck, and jaw to look for swelling, gas, pus, or inflammation.

What Are the Treatment Options?

Ludwig’s angina is a serious infection that can spread rapidly. It needs immediate treatment to get the infection under control and ensure your airway remains open.

The first treatment is to make sure you can breathe properly. If your breathing is partially restricted, you may receive a breathing tube through your mouth or nose. If your breathing is severely restricted, you will receive a tracheotomy surgical procedure to insert a breathing tube into your windpipe.

Ludwig’s angina causes a lot of fluid buildup in the neck and jaw area, so it’s important to drain this fluid so you can get relief. Doctors make an incision to drain the fluid and help you breathe easier.

You will also receive intravenous (IV) antibiotics that help treat bacteria in the mouth. Once your infection clears, your doctor may give you a prescription for oral antibiotics to ensure the symptoms don’t return.

What Are the Complications?

With immediate treatment, you can expect a good recovery with minimal to no lasting effects. However, there are numerous complications of having Ludwig’s angina if it’s left untreated.

You may develop serious or life-threatening complications such as:

  • Sepsis
  • Septic shock
  • Lung infection with pus
  • Suffocation
  • Heart inflammation or infection
  • Blood clot in the neck
  • Aneurysm bulge in the carotid artery
  • Chest inflammation

These complications could even lead to premature death because the infection spreads so quickly and can block airflow. Immediate treatment for Ludwig’s angina is the best course of action.

Can You Prevent Ludwig’s Angina?

‌In most cases, you can help prevent this rare but serious skin infection.

One of the first preventive measures should be good oral hygiene. Make sure you brush and floss your teeth each day and see a dentist for regular cleanings. During your appointment, your dentist will check for signs of tooth decay, infection, or plaque buildup.

You should try to avoid tongue piercings and other mouth piercings that could let bacteria invade the jawbone and soft tissues. And if you have any dental pain, gum bleeding, or loose teeth, make an appointment with your dentist as soon as possible.

Along with regular dental checkups, get regular doctor checkups and keep your doctor informed about any dental infections you had. They may order blood cultures and blood tests to check for signs of lingering infection.

With good care and a healthy diet, you can reduce your risk of getting Ludwig’s angina.

Show Sources

SOURCES:

An, J.; Madeo J.; Singhal, M. Ludwig Angina, StatPearls Publishing, 2021. 

EMBlog Mayo Clinic: “A pain in the neck. Ludwig’s Angina.”

Journal of Natural Science, Biology and Medicine: “Ludwig's Angina – An emergency: A case report with literature review.”

Merck Manual: “Submandibular Space Infection.”

The American Journal of Medicine: “Ludwig’s Angina.”

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