Ludwig’s angina – what you need to know

Ludwig’s angina is rare, but it can be life-threatening if it isn’t treated quickly, so it’s important to know the symptoms.


What are the symptoms?

What are the causes?

When to see a doctor

How is it diagnosed?

What are the treatments?

Ludwig’s angina is a serious condition that can develop from a tooth infection, and spread rapidly to your tongue and neck. It can cause severe swelling, which may also affect your breathing. The condition can be dangerous, but most people recover well with early treatment.

Ludwig’s angina is a rare infection that can affect the neck and the floor of your mouth. This can develop under your tongue (sublingual space) or beneath your lower jaw (submandibular space). 

The condition isn’t related to the type of angina that causes chest pain. Instead, Ludwig’s angina is a type of [cellulitis](https://www.livehealthily.com/health-library/conditions/cellulitis), an infection that’s caused by bacteria getting through a break in the skin. 

The cellulitis infection starts in your mouth, usually from a tooth infection (abscessed tooth). It then spreads rapidly to your tongue and throat, causing swelling, which can affect your breathing. 

__That’s why Ludwig’s angina is a medical emergency – if you or someone else has symptoms, always call an ambulance.__

## What are the symptoms?

Signs of Ludwig’s angina usually come on quickly and may include:

- fever or chills
- difficulty speaking 
- toothache
- pain, swelling and/or redness in your neck
- a tender, swollen tongue
- swollen cheeks and jaw
- pain in your jaw.

Swelling in your neck can affect your breathing, causing: 

- confusion
- fatigue
- noisy, raspy breathing
- difficulty swallowing, which causes drooling as you can’t swallow your own saliva.

Always get emergency medical care if you have problems breathing or swallowing. Left untreated, the infection can also get into your bloodstream and lymph nodes, causing [sepsis](https://www.livehealthily.com/health-library/conditions/blood-poisoning), another life-threatening condition, where you need emergency help. 


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## What are the causes?

In 9 out of 10 cases, Ludwig’s angina is caused by an infection in the second or third molar in your lower jaw. 

Less commonly, it can be triggered by other wounds inside your mouth, as a result of tongue piercings, a broken jaw, or a tooth extraction, for example. You’re more likely to develop it if:

- you’ve had recent dental treatment
- you have poor dental hygiene and problems with your teeth and gums. 

Healthy people can develop Ludwig’s angina, but some health conditions may raise your risk, such as:

- [diabetes](https://www.livehealthily.com/health-library/conditions/diabetes)
- lowered immunity after an organ transplant.

## When to see a doctor

If you have Ludwig’s angina symptoms, such as difficulty breathing or swallowing, get medical care immediately. You should contact your healthcare provider if you have signs of infection, swelling, or pain in your neck, cheek, or jaws, as well as toothache, or a sore, tender tongue.

If you’re concerned about your risk of Ludwig’s angina, or you have any oral problems, such as toothaches or sores, see your dentist for treatment and advice on oral hygiene. 

It’s also a good idea to keep up regular dental check-ups so that you can prevent problems starting.

## How is it diagnosed?

Usually, a healthcare professional will diagnose Ludwig’s angina based on your symptoms. Their top priority is to clear blocked airways and bring down swelling, so they’ll only carry out further checks after that. 

You may need a CT scan to see how severe the infection is, and to check for signs of abscess. 

## What are the treatments?

Treatments for Ludwig’s angina may include:

- __a procedure called a tracheostomy__, if swelling is affecting your breathing. This is where a surgeon makes a hole through your neck into your windpipe, so oxygen can be delivered straight to your lungs
- __intravenous (IV) antibiotics and corticosteroids__ to fight the infection and bring down swelling
- __surgery__ to drain the infection.

Ludwig’s angina can be a frightening experience, but the good news is that most people make a recovery.

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References

Charlotte Haigh

Jo Wheatley

Dr Tamer T Malak

Article information

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Ludwig’s angina is a rare bacterial infection of the floor of the mouth, under the tongue. It happens when a tooth infection spreads past the tooth. Here are the symptoms of Ludwig’s angina and how to treat it.