Ludwigs Angina: No Ordinary Pain in the Neck

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Ludwigs angina is a serious, potentially life-threatening bacterial infection that stems from an infected or traumatized mandibular second or third molar (wisdom) tooth. This condition is usually seen only in adults, but there are some reported cases in older children. This severe, quick-spreading infection develops in the floor of the mouth or under the tongue and manifests as a cellulitis – a connective tissue infection. Unlike other bacterial infections of the mouth, Ludwigs angina develops and spreads in the submandibular and sublingual areas of the lower jaw, causing neck pain and swelling. If left untreated, it may obstruct the airway.

A case study published by the Journal of Natural Science, Biology and Medicine highlights the severity of this infection and why it warrants immediate treatment, which includes maintaining the airway and surgical drainage of the infection, followed by a course of intravenous (IV) antibiotics. A compromised airway is considered the most serious symptom and is usually addressed before treating the infection. This is usually done by inserting a tracheostomy tube to ensure that the airway remains open. Secondarily, dealing with the bacterial source, including the infected tooth, becomes the next priority in treatment.

Why So Serious?

Why is this different from a tooth infection that needs treatment like a root canal? In most cases, this condition stems from an untreated infection in the second or third molars of the lower jaw. The bacteria that are normal to the oral cavity are allowed to proliferate and spread from the roots into the spaces between the muscles and tissue of the jaw. Why these particular teeth? The roots of these teeth lie in the deeper spaces of connective tissue and muscle in this area of the jaw. Consequently, the infection causes an edema in the sublingual (under the tongue) and submandibular (under the jaw) area, causing swelling and pain under the tongue and neck. It is especially prevalent in immunocompromised individuals, but it can develop in healthy patients. That's why it is critical to see your dentist at the first sign of pain and swelling at the angle of the jaw.

Symptoms and Treatment

The symptoms vary, but almost always include a sore throat and discomfort with swallowing as well as a report of painful neck swelling. Other tell-tale signs are toothache, tiredness or malaise and a low-grade fever. Very often the early symptoms are dismissed as "just a virus" with the toothache being unrelated. However, the more serious symptoms, especially the airway obstruction, can occur rapidly and develop into a life-threatening incident. If seen by a dentist in the early stages, a referral to a dental specialist like an oral surgeon or ear, nose and throat doctor is common. If airway obstruction is suspected, it becomes a situation best treated in the emergency department of a hospital.

A CT scan will be performed to view the extent of the infection and to monitor the airway. As mentioned, the infection can only be resolved with an incision and drainage and subsequent IV antibiotic therapy for several days. If the infected tooth or teeth are still present, extractions may be necessary to facilitate complete healing. Once the symptoms have subsided, antibiotics may be prescribed to take by mouth for several weeks after discharge.

The best way to avoid a condition like Ludwigs angina is to seek regular dental care. By seeing your dentist and dental hygienist routinely, small cavities and gum problems can be recognized and treated in the early stages. Additionally, good hygiene habits are key. Floss and brush twice daily with a toothpaste like Colgate Total Daily Repair toothpaste, which repairs early teeth and gum damage and strengthens teeth by remineralizing weakened enamel. Oral and systemic health are linked, so ensure that your teeth are healthy and your body will follow suit.

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