What Is Ludwig’s Angina?

Written by Katie Cameron
Medically Reviewed by Jabeen Begum, MD on June 04, 2025
4 min read

Ludwig’s angina is a rare but serious bacterial skin infection that affects your mouth, neck, and jaw. Considered a type of cellulitis, Ludwig’s angina spreads rapidly to infect the soft tissues below your tongue.

This serious condition is more common in adults than in children. It causes the tongue to rise as the infection spreads. If left untreated, it may result in breathing difficulties or airway blockage.

Bacteria from dental infections or poor oral hygiene can cause of this skin infection. You can get Ludwig’s angina if you have a cavity or tooth abscess (often in your second and third molars) or if you get periodontitis or gingivitis.

Streptococcal and staphylococcal bacteria are the most common types of bacteria that lead to Ludwig’s angina, especially Streptococcus viridans, Staphylococcus epidermidis, and Staphylococcus aureus.

You might be at risk for Ludwig’s angina if you have any of the following:

  • Jawbone fracture
  • Tongue piercing
  • Jawbone infection
  • Mouth injury
  • Tonsil abscess
  • Salivary gland infection
  • Thyroglossal cyst

Oral hygiene is important for many reasons, including reducing your risk for serious conditions, such as Ludwig’s angina.

You often experience fever, mouth pain, neck swelling, and a swollen tongue when you have Ludwig’s angina.‌

Other symptoms you may experience include:

Severe or untreated Ludwig’s angina can cause symptoms such as:

It’s important to treat Ludwig’s angina as soon as you notice symptoms, as the condition can worsen quickly. See your doctor or go to the emergency room right away if you’re experiencing symptoms such as:

  • Trouble breathing
  • Worsening or severe jaw pain
  • Swelling in your neck and jaw

If you’ve been treated for Ludwig’s angina and your symptoms don’t improve, contact your doctor as soon as possible.

Your doctor will give you a physical exam to check your neck, jaw, lymph nodes, the inside of your mouth, your chest, and lungs. In most cases, this physical exam shows enough symptoms to diagnose Ludwig’s angina.

‌If your doctor can’t make the diagnosis, they may order blood and salivary cultures to check for bacteria. They may also order a CT or MRI scan using contrast dye. These scans look at your mouth, neck, and jaw to check for swelling, gas, pus, or inflammation.

Ludwig’s angina is a serious infection that can spread rapidly. It needs immediate treatment to get the infection under control and ensure your airway remains open.

The first treatment is to make sure you can breathe properly. If your breathing is partially affected, you may receive a breathing tube through your mouth or nose. If your breathing is severely blocked, you will receive a tracheotomy — surgery to insert a breathing tube into your windpipe.

Ludwig’s angina causes a lot of fluid buildup in the neck and jaw area, so it’s important to drain this fluid for relief. Doctors make an incision to drain the fluid and help you breathe easier.

You will also receive IV antibiotics that help treat bacteria in the mouth. Once your infection clears, your doctor may give you a prescription for oral antibiotics to ensure the symptoms don’t return.

With immediate treatment, you can expect a good recovery with minimal to no lasting effects. But, if left untreated, Ludwig’s angina can cause many complications.

You may get serious or life-threatening complications, such as:

  • Sepsis
  • Septic shock
  • Lung infection with pus
  • Suffocation
  • Heart inflammation or infection
  • Blood clot in the neck
  • Aneurysm bulge in the carotid artery
  • Chest inflammation

These problems could even lead to premature death because the infection spreads quickly and can block airflow. Getting immediate treatment for Ludwig’s angina is the best course of action.

‌In most cases, you can help prevent this rare but serious skin infection.

One of the first preventive measures should be good oral hygiene. Make sure you brush and floss your teeth each day and see a dentist for regular cleanings. During your appointment, your dentist will check for signs of tooth decay, infection, or plaque buildup.

You should try to avoid tongue piercings and other mouth piercings that could allow bacteria to invade your jawbone and soft tissues. And if you have any dental pain, gum bleeding, or loose teeth, see your dentist as soon as possible.

Along with regular dental checkups, also see your regular doctor for checkups. Keep your doctor informed about any dental infections you have had. They may order blood cultures and blood tests to check for signs of lingering infection.

With good care and a healthy diet, you can lower your risk of getting Ludwig’s angina.

How quickly does Ludwig’s angina develop?

This condition develops very quickly. Swelling in the neck can appear within half an hour of infection.

Can Ludwig’s angina be cured?

Yes, most of the time, Ludwig’s angina can be treated successfully with airway treatments like breathing tubes, antibiotics to treat the infection, and surgical drainage.

Is Ludwig’s angina life-threatening?

Yes. If left untreated, Ludwig’s angina can block your airway and be fatal in more than 50% of cases. With antibiotics, the condition’s mortality rate is 8%.