Ludwig angina is an infection of the floor of the mouth under the tongue. It is often due to a bacterial infection of the teeth or jaw.

Submandibular space infection; Sublingual space infection; Ludwig's angina

Ludwig angina is a type of bacterial infection that occurs in the floor of the mouth, under the tongue. It often develops after an infection of the roots of the teeth (such as tooth abscess) or a mouth injury.

This condition is uncommon in children.

The infected area swells quickly. This may block the airway or prevent you from swallowing saliva.

Symptoms include:

• Breathing difficulty
• Difficulty swallowing
• Drooling
• Unusual speech (sounds like the person has a "hot potato" in the mouth)
• Tongue swelling or protrusion of the tongue out of the mouth
• Fever
• Neck pain
• Tooth pain
• Neck swelling
• Redness of the neck

Other symptoms that may occur with this disease:

• Weakness, fatigue, excess tiredness
• Confusion or other mental changes
• Earache

If the swelling blocks the airway, you need to get emergency medical help right away. A breathing tube may need to be placed through your mouth or nose and into the lungs to restore breathing. You may need to have surgery called a tracheostomy that creates an opening through the neck into the windpipe.

Antibiotics are given to fight the infection. They are most often given through a vein until symptoms go away. Antibiotics taken by mouth may be continued until tests show that the bacteria have gone away.

Dental treatment may be needed for tooth infections that cause Ludwig angina.

Surgery may be needed to drain fluids that are causing the swelling.

Ludwig angina can be life threatening. It can be cured with getting treatment to keep the airways open and taking antibiotic medicine.

Complications may include:

• Airway blockage
• Generalized infection (sepsis)
• Septic shock

Breathing difficulty is an emergency situation. Go to the emergency room or contact the local emergency number (such as 911) right away.

Contact your provider if you have symptoms of this condition, or if symptoms do not get better after treatment.

Visit the dentist for regular checkups.

Treat symptoms of mouth or tooth infection right away.

Published Date: January 29, 2025
Published By: Ashutosh Kacker, MD, FACS, Professor of Clinical Otolaryngology, Weill Cornell Medical College, and Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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