A bacterial infection that starts in the mouth and spreads quickly, causing breathing problems, is called Ludwig’s angina. It is a type of cellulitis, and people who develop it may also experience the following symptoms. For example, fever, drooling, and neck pain. Physicians often treat this condition with antibiotics and surgery to drain the infection. Generally, Ludwig’s angina is considered a medical emergency that requires immediate treatment.
While this infection may occur after a mouth injury, it usually happens due to an abscessed (infected) tooth. The name of this bacterial infection comes from the German physician Wilhelm Friedrich von Ludwig, who first described this disorder in 1836. The medical term “angina” is used by doctors to describe severe pain in a specific part of the body.
What Are The Symptoms of Ludwig Angina?
People who develop this infection usually experience the following symptoms. Examples include:
- Dysphagia (swallowing problems)
- Shortness of breath (dyspnea)
- Drooling
- Jaw pain or swelling
- Neck pain, swelling, or discoloration
- Slurred speech
- Toothache
- Tongue tenderness or pain
- Protruding swollen tongue
- Fever
- Chills
If any of the previous symptoms occur, immediately contact your healthcare professional. Otherwise, it may lead to serious complications. Furthermore, this infection is not contagious. It means it cannot spread from one person to another.
Causes and Risk Factors
While about 90% of diagnosed cases occur due to an abscessed lower molar tooth, it may also happen due to other causes. Check some of them below:
- An injury inside the mouth (especially around the back of the lower jaw)
- Oral surgery complications
- Pericoronitis (gum inflammation around a wisdom tooth)
Most of the time, Ludwig angina occurs due to the following types of bacteria. These include Streptococcus, Staphylococcus, and Bacteroides.
While anyone can develop this infection, physicians have found some factors that may increase your risk. For example:
- Oral cancer
- Poor oral hygiene
- Diabetes
- Cavities
- Alcohol use disorder
- Weakened immune system
- Malnutrition
What Are The Potential Complications of Ludwig’s Angina?
People who leave this infection untreated may also experience some complications. Check some examples below:
- Blocked airway
- Aspiration pneumonia
- Asphyxiation (sudden lack of oxygen that occurs when swelling pushes the tongue up and back)
- Sepsis (a life-threatening infection)
- Mediastinitis (chest infection)
- Septic shock (this is a severe form of sepsis that causes a sudden low blood pressure)
- Multi-organ failure
- Blood clots
- Pericarditis
- Osteomyelitis (bone infection)
- Necrotizing fasciitis
This article does not contain a full list of Ludwig’s angina complications. Early detection and prompt treatment may help prevent these complications.
Is There a Way to Prevent Ludwig’s Angina?
However, it is not always possible to prevent this bacterial infection, but maintaining good oral hygiene and regularly visiting your dentist may help reduce the risk. Remember, it is essential to treat dental infections promptly because they are the most common cause of this bacterial infection.
Diagnosis
Healthcare professionals can diagnose this condition during a physical examination. They often look for swelling around the front of the neck and underneath the jaw, and check for an enlarged tongue. When it is not clear, doctors will also perform the following tests to confirm or rule out Ludwig angina. For example:
- Bacteria culture test – During this test, doctors will take a sample of blood to check whether the infection has spread to the bloodstream.
- CT (computerized tomography) scans – This is an imaging test that helps doctors determine the severity of the infection. It may also be used to detect abscesses.
- Ultrasound – This is another imaging test that uses sound waves to make images of different parts of the body. It often detects blood clots and pockets of infection. Sometimes, physicians perform an ultrasound to check whether the infection has spread to the bones.
Treatment
Healthcare professionals recommend different treatments for people with this bacterial infection. They usually depend on the severity and exact cause of the infection, age, existing health problems, and preferences. Check some options below:
- Opening the airway – The primary goal of the treatment is to open the airways and give you oxygen. Healthcare professionals often perform it by placing a thin and flexible tube (nasal cannula) into the nose and down the throat.
- Medicines – When your airway is open, physicians will give you IV (intravenous) antibiotics to clear the infection. In some cases, they may also prescribe corticosteroids to reduce inflammation (swelling).
- Surgery – This treatment is recommended by doctors in more severe cases to drain the infection. You may also need to remove the infected tooth.
Frequently Asked Questions
When should I see my healthcare professional?
If you experience breathing or swallowing problems, severe pain, or swelling around the neck or under the jaw, immediately go to the local emergency room (ER).
What is the prognosis for people with Ludwig angina?
In most cases, people with this bacterial infection survive, especially those who take antibiotics as soon as possible. However, early detection and treatment are still vital. Unfortunately, approximately 8% of people who develop this condition die from swelling and lack of oxygen.
What is the main cause of Ludwig angina?
This is a severe bacterial infection that easily spreads to the tongue and neck. Most people develop it due to an untreated abscessed lower molar. In any case, it may also happen due to other causes, including mouth injuries, oral cancer, and others.
Can Ludwig’s angina be life-threatening?
Yes. Ludwig’s angina is a life-threatening medical emergency because the swelling can quickly block the airway and make breathing difficult. Without prompt treatment, the infection may spread to the bloodstream or other parts of the body, leading to severe complications.
Who is most likely to develop Ludwig’s angina?
Although anyone can develop Ludwig’s angina, it is more common in adults with untreated dental infections, poor oral hygiene, diabetes, weakened immune systems, alcohol use disorder, or malnutrition. Prompt treatment of tooth infections can significantly reduce the risk.
How quickly does Ludwig’s angina develop?
Ludwig’s angina usually progresses rapidly, often within hours to a few days after a dental infection or injury to the mouth. Because symptoms can worsen quickly, it is important to seek emergency medical care as soon as swelling, difficulty swallowing, or breathing problems develop.
Can Ludwig’s angina return after treatment?
Yes, although recurrence is uncommon, it happens when the underlying cause is properly treated. Removing the source of the infection, such as an abscessed tooth, completing the full course of antibiotics, and maintaining good oral hygiene can help prevent it from coming back.
How long does it take to recover from Ludwig’s angina?
Recovery depends on the severity of the infection and how quickly treatment begins. Many people start to improve within a few days after receiving intravenous antibiotics and appropriate treatment, but complete recovery may take several weeks, especially if surgery is required.
Can children develop Ludwig’s angina?
Yes. Although it is more common in adults, children can also develop Ludwig’s angina, particularly after dental infections or injuries to the mouth. Because children have smaller airways, rapid medical evaluation and treatment are especially important.
Can poor dental hygiene increase the risk of Ludwig’s angina?
Yes. Poor oral hygiene can lead to tooth decay, gum disease, and dental abscesses, which are the leading causes of Ludwig’s angina. Brushing and flossing daily, having regular dental checkups, and treating dental infections promptly are among the best ways to reduce the risk of developing this serious condition. Ask your healthcare provider if you have any other questions.
