“Good hygiene is half the health!” is a phrase we’ve heard since childhood. Oral hygiene and proper care of our oral cavity are significant factors in maintaining the overall health of the body. Although there has been increasing focus in dentistry in recent years on educating patients about the importance of maintaining oral hygiene and attending regular check-ups, a large percentage of treatments still fall under emergency cases.
These conditions require immediate intervention to alleviate discomfort and prevent the worsening of the patient’s health and life-threatening situations. One such condition is swelling originating from a tooth, also known as an acute apical abscess, which can spread diffusely through surrounding tissues and lead to a severe condition – phlegmon of the mouth floor.
Phlegmon of the mouth floor, also known as Ludwig’s angina, is a serious infection of the soft tissues in the lower jaw area. It is a life-threatening bacterial inflammatory process of acute onset that rapidly spreads through the tissues of the floor of the oral cavity, affecting the area beneath the tongue and spreading to the lower jaw region. Due to the close relationship of these areas with the mediastinum, large blood vessels, and the heart, phlegmon of the mouth floor is potentially life-threatening and requires urgent medical intervention!
Causes
Phlegmon of the mouth floor most commonly occurs as a result of a dental infection, usually due to untreated cavities that progress into the root canal or a periapical abscess, i.e., inflammation around the roots of lower teeth (most often lower molars), from which it typically spreads. Bacteria from the affected tooth spread from the root area to the surrounding soft tissues of the mouth floor, causing swelling, pain, and infection spreading.
Symptoms
The symptoms of this serious infection are extremely unpleasant for the patient and progress rapidly. The main symptoms include:
- Severe pain and swelling in the area beneath the lower jaw and neck,
- Redness and warmth of the skin around the affected area,
- Difficulty opening the mouth (trismus),
- Difficulty swallowing and speaking,
- Breathing difficulties due to pressure on the airways,
- High fever and a general feeling of weakness.
Complications
If left untreated, phlegmon of the mouth floor can lead to severe complications. The most dangerous include:
- Airway obstruction: Swelling can compress the airways, leading to suffocation.
- Sepsis: Bacteria from the infection enter the bloodstream, causing sepsis, which is life-threatening.
- Infection spreading: The infection can spread to other parts of the head and neck, including the mediastinum (the space between the lungs), which is life-threatening.
Diagnosis
The diagnosis of Ludwig’s angina is based on a clinical examination and the symptoms described by the patient. Imaging studies, such as CT (computed tomography) and ultrasound, can help assess the extent of the infection and plan treatment, but the primary diagnosis required for patient treatment can be made based on a clinical examination in the dental office.
Treatment
Given the rapid progression of this infection and its potential life-threatening nature, phlegmon of the mouth floor requires the patient’s urgent admission and treatment. Treating this bacterial infection involves the following steps, performed in hospital settings:
- Antibiotics: Broad-spectrum antibiotics are administered intravenously to quickly suppress the infection. Combinations of antibiotics targeting both anaerobic and aerobic bacteria are commonly used.
- Drainage: This involves allowing the pus collection to drain. This often includes extracting the affected tooth and making a surgical incision. Surgical drainage is frequently necessary to remove the pus and reduce pressure. Drainage is performed through incisions beneath the lower jaw.
- Airway support: In severe cases, when swelling threatens breathing, the patient may require intubation or tracheotomy to maintain airway patency.
How to Prevent Phlegmon of the Mouth Floor?
The best way to prevent this condition is to maintain good oral health. Regular dental check-ups, timely treatment of cavities and infections, and proper oral hygiene reduce the risk of developing this serious condition. Phlegmon of the mouth floor is rare but very serious and can have severe consequences. Quick reaction and proper treatment are essential for successful recovery and preventing complications. Therefore, we recommend regular visits to the dentist to address cavities promptly and prevent their progression into acute conditions.
Schedule your regular check-up today!
