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Dentistry 2023

Ludwig's angina: what é, symptoms, causes and treatment

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Ludwig's angina: what é, symptoms, causes and treatment
Ludwig's angina: what é, symptoms, causes and treatment

Ludwig's angina is a situation that can happen after due to changes that affect the mouth, such as abscesses in the second or third molar, jaw fracture or the presence of foreign bodies, such as piercings.

This type of problem is more common in people with a weakened immune system, being caused by bacteria that reach the bloodstream and increase the risk of complications such as respiratory failure and sepsis.

Symptoms of ludwig's angina include increased saliva production, high fever, pain, and difficulty opening the mouth and swallowing. It is important that the diagnosis is made as soon as the first symptoms appear, so that treatment can be started right away, which usually involves the use of antibiotics.

Main symptoms

The signs and symptoms of ludwig's angina are usually:

  • Increased saliva production;
  • Difficulty and pain to swallow;
  • High fever;
  • Weight loss;
  • Voice change;
  • Elevation of the tongue, which can cause a feeling of suffocation;
  • Presence of bloody and strong-smelling secretion;
  • Difficulty opening the mouth properly;
  • Swelling at the procedure site.

Ludwig's angina is more common in people who have some of the risk factors, such as excessive consumption of alcoholic beverages, diabetes, kidney problems, use of immunosuppressive drugs, diseases that decrease immunity, presence of piercing on the tongue, aplastic anemia or neoplasms in the oral cavity.

The diagnosis of this type of angina is very important, since the disease has a rapid evolution and can be associated with several complications. Thus, it is important that the diagnosis is made as soon as the first signs and symptoms appear, and radiography and computed tomography are usually indicated.

In addition, laboratory tests such as a blood count, tests that assess kidney function, and microbial culture followed by an antibiogram may also be recommended to identify the infectious agent and the best antibiotic to combat it..

Causes of ludwig's angina

Most cases of Ludwig's angina are related to changes in the mouth and teeth, such as the development of an abscess in the second or third molar, untreated caries or poorly performed dental procedures, for example, especially in people with a system compromised immune system.

This is due to the presence of bacteria, such as Streptococcus viridans, Staphylococcus aureus or Prevotella melaninogenica, which can develop locally and spread quickly through the bloodstream, which increases the risk of complications.

In addition, ludwig's angina can also arise due to fractures in the jaw, abscess in the tonsil, cuts in the oral mucosa, presence of foreign bodies in the mouth, cysts or tumors at the site or sialolithiasis, in which small saliva stones leading to pain, swelling and difficulty swallowing, for example. See what sialolithiasis is and how to identify it.

Possible complications

Complications of Ludwig's angina are related to the bacteria's ability to proliferate and spread rapidly through the bloodstream, reaching other organs. Thus, it can reach the mediastinum, which is one of the chest cavities, promoting compression of the heart and reaching the lungs, which can lead to severe respiratory failure.

Due to the spread of the microorganism through the bloodstream, there may also be sepsis, which is a serious situation that can also lead to death, as it promotes changes in the functioning of the organs. Learn how to identify sepsis.

How to be treated

Treatment for ludwig's angina should be started soon after diagnosis to decrease the risk of complications and is usually started with the use of medication or administration of oxygen to ensure that the person can breathe properly, as this is a serious and common complication in these cases. In some people, endotracheal intubation may even be indicated. Learn more about intubation and how it's done.

In addition, treatment must also include administration of penicillin in combination with other drugs such as metronidazole or clindamycin, injected directly into a vein, to control and fight the infection.

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