Ludwig’s Angina: Know the Symptoms and Seek Treatment Fast
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What is Ludwig’s angina?
Ludwig’s angina is a rare infection on the floor of the mouth. It causes swelling in the areas under the tongue (called the submandibular space). It’s caused by bacteria, and can be from not brushing your teeth regularly, tooth infections, or from having dental work.
The swelling can become so severe that it affects your ability to breathe. It can quickly become life-threatening, and you may need to go to the emergency room. They will help you breathe and start you on antibiotics to treat the infection.
People with a weak immune system, including those with HIV or taking drugs that weaken it, are more susceptible to Ludwig’s angina.
One common misconception is Ludwig’s angina is a simple dental infection. Most dental infections are localized. But with Ludwig’s angina, the infection spreads rapidly. It can quickly lead to airway obstruction or death if not treated early. —Dr. Chandra Manuelpillai
Ludwig’s angina symptoms
Patients often hold their mouth open due to swelling that causes their tongue to be lifted up and forward. On exam, the floor of the mouth is elevated or swollen and the area under the lower jaw is swollen. There is often a history of poor dental hygiene, known dental fractures, or recent dental procedures. —Dr. Manuelpillai
The floor of your mouth will begin to swell, on both sides of your mouth. It causes dull pain below and around the tongue. You may find it hard to move your tongue, swallow, and speak. And you may start drooling a lot.
As the infection worsens, it will become difficult to breathe. You may notice you’re leaning over with your hands on a table—a position called “tripoding”—in order to breathe.
Most common symptoms
Ludwig’s angina causes
The main causes of Ludwig's angina are not taking good care of your teeth (poor dental hygiene) and having dental procedures. Poor dental hygiene means you have too much bacteria in your mouth. It also can lead to gum disease, tooth infections, and more frequent dental procedures.
At the bottom of the roots of your teeth, there is a space in the jaw called the submandibular space. If bacteria from the roots of the teeth get into this space, either due to gum disease or dental procedures, they can cause an infection. That leads to Ludwig’s angina.
Dental procedures are a risk because they cause minor trauma to gum tissue, which can release harmful bacteria.
People with weakened immune systems, such as those with HIV, or if you’re taking a medication that suppresses your immune system, are at a greater risk of Ludwig's angina.
How do you treat Ludwig’s angina?
Ludwig’s angina is an emergency and you should call 911 or get to the nearest emergency room as quickly as possible.
You will be admitted to the hospital for close monitoring, imaging tests, like a CT scan, and you will receive intravenous (IV) antibiotics.
The doctors will monitor the swelling and your airways to make sure your breathing isn’t compromised. If you can’t breathe well enough on your own, you may have to have a flexible tube put down your throat (intubation) to pump oxygen in. If your mouth or throat is too swollen, they may put the tube in through your nose or neck (tracheostomy).
You will need IV antibiotics for 2 to 3 weeks. Once you can breathe on your own, you will probably be sent home with a special catheter (tube) inserted so you can continue to get the antibiotics at home. It’s important that you complete the entire round of antibiotics as directed by a doctor—or else the infection could recur.
Taking care of your teeth can reduce your risk of Ludwig’s angina. It reduces the amount of bacteria in your mouth and the need for dental procedures. Good oral hygiene includes twice daily brushing of teeth and daily flossing.
If you’ve had Ludwig’s angina, your dentist may have other recommendations to reduce your risk of getting it again.
It is important to mention that this disease may be prevented with proper dental hygiene and regular dental visits. If you prevent the bacteria from occurring in the first place, you can avoid the possibility of it spreading and progressing to Ludwig’s angina. —Dr. Manuelpillai
Dr. Henry is a first-year resident in the Department of Otolaryngology-Head & Neck Surgery at the University of Pennsylvania. She received her medical degree from the University of Pennsylvania and her BA in political economy from Williams College. As a medical student, she was the editorial manager of an otolaryngology publication and has extensive experience with medical writing. She is currently working on research projects for publication in the sub-specialty fields of otology, head and neck cancer, and facial plastics. Outside the hospital she enjoys fly fishing, squash, hiking, and watching pro tennis.