Most tooth infections stay near the tooth. Rarely, infection spreads into the floor of the mouth and neck and becomes a medical emergency called Ludwig angina. MedlinePlus, from the National Library of Medicine, describes it as an infection of the floor of the mouth under the tongue, often due to a bacterial infection of the teeth or jaw. Knowing the warning signs, and treating tooth infections early, matters.
If someone has trouble breathing, go to the emergency room or call 911 right away.
Causes
MedlinePlus says Ludwig angina often develops after an infection of the roots of the teeth, such as a tooth abscess, or a mouth injury. It is uncommon in children. MedlinePlus also lists it as a possible, though uncommon, complication of salivary gland infections. See tooth abscess signs and salivary gland infections.
Symptoms
The infected area swells quickly. MedlinePlus warns this can block the airway or prevent you from swallowing saliva. Symptoms include:
- breathing difficulty and difficulty swallowing
- drooling
- unusual speech that sounds like a “hot potato” in the mouth
- tongue swelling, or the tongue pushing out of the mouth
- fever
- tooth pain, neck pain, neck swelling and redness of the neck
Other symptoms can include weakness, fatigue, confusion or other mental changes, and earache.
Diagnosis
A provider examines the head and neck for redness and swelling of the upper neck, under the chin. The swelling may reach the floor of the mouth, and the tongue may be swollen or pushed up. MedlinePlus says a CT scan of the head and neck may be needed, and fluid may be tested for bacteria.
Treatment
- Airway first: if swelling blocks the airway, emergency help is needed right away. A breathing tube may be placed through the mouth or nose, or a tracheostomy (an opening through the neck into the windpipe) may be done.
- Antibiotics: most often given through a vein until symptoms go away, then possibly by mouth until tests show the bacteria are gone.
- Dental treatment for the tooth infection that caused it.
- Surgery may be needed to drain fluids causing the swelling.
Outlook and complications
MedlinePlus says Ludwig angina can be life threatening, but it can be cured with treatment that keeps the airway open and antibiotics. Complications include airway blockage, generalized infection (sepsis) and septic shock.
When to get help
- Breathing difficulty: an emergency. Go to the ER or call 911.
- Contact your provider if you have symptoms of this condition, or if symptoms don’t improve after treatment.
For other urgent dental signs, see what counts as a dental emergency.
Prevention
MedlinePlus advises regular dental checkups and treating symptoms of mouth or tooth infection right away. See how often to see the dentist and toothache causes.
Frequently asked questions
Can a toothache really become this serious?
Rarely. MedlinePlus says Ludwig angina often develops after an infection of the tooth roots, such as an abscess.
Is it common in children?
No. MedlinePlus says it is uncommon in children.
Sources
By the Dentist Review Editorial Team.
This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
Featured image: “Emergency Room – RSU MMC” by RSU. Manado Medical Center, via Wikimedia Commons, licensed CC BY-SA 4.0. Resized and compressed for the web.
Our guides are written and reviewed by the Dentist Review editorial team. We research each topic using public, authoritative sources such as the CDC, the National Institutes of Health (NIH/NIDCR), the American Dental Association (ADA) and CMS, and we update guides when guidance changes. Guides are for general information only and are not dental or medical advice; please read our disclaimer and learn more about us.