What is Ludwig Angina? – Its Causes, Symptoms & Diagnosis

Ludwig Angina

Ludwig Angina is a type of bacterial skin infection that generally infects the floor of the mouth, tongue, and the neck. It affects the mouth due to the presence of bacteria.

Patient with this disease is recommended to take antibiotic properly. However, if the patient does not take medication properly or he/she does not get proper treatment, it can lead to further complications including sepsis.

The most patient of this disease has reported dental issues including pain, swelling, or dental procedures.

In this article, we will provide you with more information about this bacterial infection that affects the mouth.

What is Ludwig Angina?

 A case of Ludwig Angina

Ludwig Angina is a bacterial skin infection that causes swelling on the floor of the mouth including under the tongue and neck. It is firstly identified 1n 1836 by Wilhelm Friedrich von Ludwig.

Ludwig is similar to cellulitis. However, it can cause severe swelling around the mouth floor. Moreover, it can cause severe swelling that may obstruct the patient’s airways and it may be the reason for breathing problems.

If a patient does not get proper care, it can be a life-threatening condition. A patient with breathing issues should receive emergency medical help.

Apart from the breathing issue, if a person finds any other symptoms of this disease, he should ask for emergency medical help.

In Ludwig, the area around submandibular space is the first site of infection. This space is present inside the sublingual space. Most cases of this disease are reported around the second and third molar.

Once the infection develops around the teeth, it spread throughout the mouth and neck. This is developed by most commonly known bacteria such as Staphylococcus, Bacteroides, and Streptococcus.

Symptoms of Ludwig Angina


Ludwig causes swelling inside the mouth floor including toung and neck. The swelling can be more severe that may obstruct the airways pathway.

The most common symptoms of this Ludwig Angina are given below. If you notice any of these symptoms, ask for the medical help before the condition gets more severe.

  • fever and pain
  • swelling around neck
  • swelling inside the mouth
  • difficulty breathing
  • difficulty swallowing
  • mouth pain
  • toung swelling
  • voice hoarseness
  • sore throat

If the patient experience difficulty in breathing, he/she should ask for emergency medical attention.

Apart from this, if he/ she experience other symptoms of this disease, they should visit a doctor as soon as possible, as early proper treatment and care must be helpful to prevent the severe complications.

Causes of Ludwig Angina

Ludwig Angina is the bacterial mouth infection that generally occurs by the group of bacteria including Staphylococcus, Bacteroides, and Streptococcus. It generally affects the sublingual part of toung.

In most cases, the second molar and third molar are the prime regions of the infection.  Apart from bacteria, cuts or other injuries in the mouth, poor dental hygiene, or tooth surgeries may be the cause of disease.

Patient with autoimmune diseases such as diabetes, HIV positive, kidney disorders, and liver cirrhosis are at high risk for Lugwig Angina due to the development of atypical micro-organism.

Apart from this, a healthy person might also develop an infection.  Nevertheless,   several healthy patients have been reported to this disease. Even most cases are reported to predispose the patient to Ludwig angina.

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Diagnosis of Ludwig Angina

Generally, the doctor starts with the physical examination to check swelling and redness around the mouth and neck area.

Moreover, he/she will perform the examination with the help of fluid culture and imaging tests to clearly the Ludwig Angina.

A medical practitioner check the following symptoms usually help to diagnose the Ludwig Angina.

  • A doctor would check your head, neck, and tongue that may visible redness and swell around these parts.
  • The swelling may spread throughout the mouth floor including airways and inside the mouth.
  • Your tongue maybe not at the right place.

If the medical practitioner is not sure with the physical examination, he may ask the patient to go with other tests such as an MRI or CT scan. However, these tests may confirm the swelling on the mouth floor.

Along with this, your doctor may ask for the fluid cultures to identify the specific micro-organism that causes the Ludwig Angina.

Treatment of Ludwig Angina

Treatment of Ludwig

Proper care of this disease is important. A few ways are given below to treat the disease.

Cleaning of Airway

In severe cases, swelling around the neck blocks the breathing airways that causes difficulty in breathing. If the patient experience the trouble breathing, your doctor should clean the blocked pathway first.

A medical practitioner may insert a breathing tube through the nasal passage inside your lungs.  In a few cases, they need to create an opening to reach windpipe. This is performed in the emergency.

Drain Excess Fluids

This disease can cause an obstruction in airways, distortion, and swelling the mouth floor. Surgery is the only way to get control of emergency situation. However, it helps to remove excess fluids that are the main reason for swelling in the oral cavity.


Ludwig angina is a bacterial infection of the mouth. A patient needs antibiotics through the IV until the symptoms go away.

Once the symptoms get faded, you can continue with oral medication until the laboratory reports show that the bacteria have gone away.

Apart from the above treatments, the patient needs to get additional treatment for a mouth infection.


Ludwig angina can be a life-threatening condition if it won’t be taken seriously. A few complications can happen with a severe condition.

  • It can block the airways further leads to breathing difficulty.
  • A severe infection may cause sepsis that is the condition of organ failure.
  • septic shock can happen due to the infection occur that may further lead to lowering of blood pressure.


Ludwig angina is a rare infection that generally occurs inside the mouth floor. it can be a life-threatening, but initial treatment can prevent the complications.

A doctor examines the disease physically to check the symptom and further go for a few lab test. Once the disease diagnosed, a treatment start with antibiotics and in serious conditions, surgery may require.

Anyone who experiences difficulty in breathing, he might have symptoms of Ludwig angina- he must ask for medical attention immediately.

General FAQs

What causes Ludwig Angina?

Ludwig Angina os a bacterial infection that affects the mouth floor including tongue and neck. it may also refer to a mouth injury. Poor dental hygiene may also cause infection.

How common is Ludwig’s Angina?

It was the most common infection that has affected 38 per cent of the population. A few patients undergo the surgery.

Does salt water help abscess?

Warm salt water twice in a day may help to relieve pain if the abscess was caused by the tooth infection. Saltwater works as an antiseptic.

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