LUDWIG’S ANGINA: A NARRATIVE REVIEW OF AETIOLOGY, PATHOPHYSIOLOGY, DIAGNOSIS AND CONTEMPORARY MANAGEMENT, WITH IMPLICATIONS FOR DENTAL PRACTICE

Objective: To provide a contemporary narrative review of Ludwig’s angina, a rapidly progressive and potentially fatal cellulitis of the floor of the mouth, with emphasis on aetiology, pathophysiology, diagnosis, airway management and treatment, and to highlight implications for dental practitioners.
Methods: The English-language literature was searched in PubMed/MEDLINE, Scopus and Google Scholar. Case series, cohort studies, reviews and clinical reports addressing the epidemiology, microbiology, diagnosis and management of Ludwig’s angina and related deep neck space infections were synthesised narratively.
Results: Odontogenic infection, particularly of the mandibular second and third molars, accounts for most cases. Infection spreads bilaterally through the sublingual, submandibular and submental spaces, elevating the floor of the mouth, displacing the tongue and progressively compromising the airway. Infections are usually polymicrobial, with streptococci and oral anaerobes predominating. Diabetes mellitus, immunosuppression and HIV infection are important comorbidities. Securing the airway is the first priority, and awake fibreoptic intubation or an early surgical airway is favoured when obstruction is threatened. Treatment combines empirical broad-spectrum intravenous antibiotics, elimination of the odontogenic source and surgical drainage where collections or clinical deterioration are present. Contemporary mortality is low with early recognition but rises with delayed airway control, mediastinitis or septic shock.
Conclusion: Ludwig’s angina remains a dental and medical emergency. Early recognition, immediate airway assessment, prompt referral and control of dental sepsis are essential to prevent morbidity and death.