Ludwig's Angina

Written by Ann Pietrangelo | Published on September 11, 2012
Medically Reviewed by George Krucik, MD

What Is Ludwig’s Angina?

Ludwig’s angina is a skin infection that occurs on the floor of the mouth, underneath the tongue. This bacterial infection often follows a tooth abscess (a collection of pus in the center of a tooth) or other mouth infection or injury. This infection is rarely seen in children.

Symptoms include swelling of the tongue, neck pain, and breathing problems. This condition is often cured with antibiotics, but may cause serious complications, such as airway blockage or sepsis (a severe inflammatory response to bacteria).

These complications can be life threatening, but with prompt treatment, most people make a full recovery.

Symptoms of Ludwig’s Angina

Ludwig’s angina often follows a tooth infection or other infection or injury in the mouth. Symptoms include:

  • pain or tenderness in the floor of your mouth, underneath your tongue
  • difficulty swallowing
  • drooling
  • problems with speech
  • neck pain
  • swelling of the neck
  • redness on the neck
  • weakness, fatigue
  • earache
  • swollen tongue pushing against your palate
  • fever, chills
  • confusion

Call your doctor if you have symptoms of Ludwig’s angina. As the infection progresses, you may also experience trouble breathing and chest pain.

If your airway is blocked, you need immediate medical attention. Go to the emergency room or call 911 for help.

Causes of Ludwig’s Angina

Ludwig’s angina is a bacterial infection. It is usually caused by the bacterium Streptococcus or Staphylococcus, and often follows a mouth injury or infection, such as a tooth abscess. Poor dental hygiene, trauma or lacerations in the mouth, or a recent tooth extraction may also contribute to Ludwig’s angina.

Diagnosing Ludwig’s Angina

Your doctor may diagnose this condition with a physical exam, fluid cultures, and imaging tests.

The diagnosis is usually based on clinical observation. The head, neck, and tongue will appear red and swollen. If diagnosis cannot be made with a visual examination, other tests may be used:

  • Contrast-enhanced magnetic resonance imaging (MRI) or computed tomography (CT) images can confirm swelling on the floor of the mouth.
  • Fluid cultures of tissue from the affected area may also be tested to identify the specific bacterium that is causing the infection.

Treatment for Ludwig’s Angina

If swelling is interfering with breathing, the first goal of treatment will be to clear your airway. Your physician may insert a breathing tube through your nose or mouth and into your lungs. In some cases, an opening can be created through the neck into your windpipe. This procedure is called a tracheotomy, and is performed in emergency situations.

Surgery is sometimes necessary to drain excess fluids that are causing swelling in the oral cavity.

Oral or intravenous antibiotics will be required to fight the infection. Any additional dental infections must also be addressed.

Long-Term Outlook

Your outlook depends on the severity of your infection and how quickly you seek treatment. Delayed treatment increases your risk for potentially life-threatening complications, such as a blocked airway, sepsis (a severe reaction to bacteria or other germs), and septic shock (infection that leads to dangerously low blood pressure).

With proper treatment, most people make a full recovery.

How to Prevent Ludwig’s Angina

You can decrease your risk of developing Ludwig’s angina by:

  • practicing good oral hygiene
  • having regular dental checkups
  • seeking prompt treatment for tooth and mouth infections
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