Ludwig’s Angina and oral piercing: a case report

Ahrens A. GSM*, Bressi T.**

* D.D. Private Dental Clinic in Nocciano, (Pe) – Italy,
** 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.

Case Report

A 25 years old female w
as 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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