Ludwig’s angina and Vincent’s (necrotising) angina
Ludwig’s angina and Vincent’s angina (acute necrotising ulcerative gingivitis - ANUG) are uncommon but potentially life‑threatening complications of oral/dental infection. Both occur more often in patients with immunosuppression, diabetes, malnutrition, heavy smoking or poor oral hygiene and may present to the emergency department.
The ED role is to recognise risk, prioritise airway safety and sepsis care, and expedite definitive source control via dental/maxillofacial/ENT teams (PHE/GOV.UK; NICE; RCEM; Resuscitation Council UK).
Definitions and pathogenesis
Ludwig’s angina
- Rapidly progressive, bilateral cellulitis of the submandibular, sublingual and submental spaces, most commonly odontogenic in origin (lower molar).
- Characteristically a diffuse “woody” cellulitis rather than a discrete abscess early on.
- Swelling elevates and posteriorly displaces the tongue, risking airway compromise.
- Polymicrobial oral flora (aerobes and anaerobes) are usually implicated; atypical organisms are more likely in immunosuppressed patients.
Vincent’s angina (ANUG)
- Necrotising infection of the gingival tissues with painful, bleeding, “punched‑out” interdental papillae and a foul odour.
- Anaerobic fusiform bacilli and spirochetes are commonly implicated.
- Usually superficial but can be associated with systemic symptoms in severe disease.
- Predisposing factors include smoking, immunosuppression, poor oral hygiene and psychosocial stress.