Ahrens A. GSM*, Bressi T.**
* D.D. Private Dental Clinic in Nocciano, (Pe) – Italy, firstname.lastname@example.org
** M.D. ENT Department, University hospital, Perugia, Italy
Ludwig’s Angina is a bacterial infection of the submandibular and sublingual space, usually following an infection of the roots of the teeth (such as a tooth abscess).
The main symptoms are pain and swelling of the tissues, fever, weakness, excessive tiredness and difficulty breathing (this symptom indicates an emergency situation).
We report a case of a patient involving Ludwig’s Angina after a tongue’s frenum piercing.
Ludwig’s Angina is a bacterial infection of the floor of the mouth which involves an inflammation of the tissues located under the tongue and which usually occurs as the result of a tooth abscess, or an injury of the mouth. The swelling of the tissues occurs quickly and may also block the airway or prevent the swallowing of saliva.
The common symptoms are pain, fever, swelling, weakness, excessive tiredness, mental confusion, difficulty breathing. Sometimes to these symptoms may be associated earache and drooling.
A 25 years old female was visited in our private dental clinic ‘cause of the swelling of the floor of the mouth that the patient supposed could be related to a tooth abscess.
By recording all the data of the patient we reported that she underwent a piercing of the tongue’s frenum two weeks before.
The tongue was displaced upward and backward ‘cause of the inflammation.
To evaluate the origins of this infections we have subjected the patient to panoramic and endoral radiographs. No lesions of the roots of the teeth were reported. Only some decays were recorded. We decided to get a culture of the fluid of the tissue and the result showed staphylococcus bacteria.
To cure the infection we administrated the patient with intravenous antibiotics until the remission of the symptoms, and then we gone on with oral antibiotics until the result of repeated culture showed the complete absence of bacteria.
The oral piercing, although perceived as a safe practice, could involve in some complications, related not only to damages of teeth and periodontal tissue (1,2,3,4,5). Many authors demonstrated the wide range of complications related by the piercing practice (6,7,8,9,10)
Our case report according to the work of Furst IM, Ersil P. and Caminiti M. (11) shows the importance that the dentists should be able to recognize the signs and symptoms of this pathology relating to its life-threatening, although it is uncommon, because a quick referral to an oral or maxillofacial surgeon in the severe cases or a good a administrated therapy will minimize the morbidity and mortality of this serious infection.
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2) Folz BJ, Lippert BM, Kuelkens C, Werner JA.“Jewelry-induced diseases of the head and neck” Ann Plast Surg. 2002 Sep; 49(3): 264-71.
3) Chambrone L, Chambrone LA. “Gingival recessions caused by lip piercing: case report.” J Can Dent Assoc. 2003 Sep; 69(8): 505-8.
4) O'Dwyer JJ, Holmes A. “Gingival recession due to trauma caused by a lower lip stud.” Br Dent J. 2002 Jun 15; 192(11): 615-6.
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6) Akhondi H, Rahimi AR. “Haemophilus aphrophilus endocarditis after tongue piercing.” Emerg Infect Dis. 2002 Aug;8(8): 850-1
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8) Friedel JM, Stehlik J, Desai M, Granato JE. “Infective endocarditis after oral body piercing” Cardiol Rev. 2003 Sep-Oct; 11(5): 252-5.
9) Shacham R, Zaguri A, Librus HZ, Bar T, Eliav E, Nahlieli O. “Tongue piercing and its adverse effects” Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Mar; 95(3): 274-6.
10) Perez Cachafeiro S , Atitar de la Fuente A, Diez Perez MD, Montero Vacas N. “Reckless perforations. Brief description of the piercing phenomenon and its possible complications” Aten Primaria. 2003 Nov 30; 32(9): 535-40
11) Furst IM, Ersil P, Caminiti M. ”Rare Complication of Tooth Abscess – Ludwig’s Angina and Mediastinitis” J Can Dent Assoc 2001; 67:324-7