Angina Swollen Tongue

Overview

The disease is well-known for its aggressiveness, rapid progression that compromises the airway and high mortality when treatment is delayed. The unhealthy condition of the mouth is typically the source of infection.^1,2,3 On both sides of your mouth, the floor of your mouth will begin to swell. It causes a numb pain below the tongue and around it. It might be hard for you to speak, swallow, and move your tongue. And you might begin to spit a lot. Breathing will become difficult as the infection worsens. In order to breathe, you might notice that you are leaning over with your hands on a table, or "tripoding".⁷ Dental caries, bacterial infection, and penetrating injuries to the floor of the mouth are all risk factors.^4,5,6 The most common cause of angina swollen tongue is the infection of the lower molars.⁸ It spreads quickly to the tissues around it, resulting in a number of potentially fatal complications like airway blockage.⁹ Dental decay and poor oral hygiene are distinct risk factors. Before the production of antibiotics, mortality surpassed 50%.¹⁰ Mortality rate has been decreased to around 8% due to surgical procedures, antibiotic therapy and rapid airway management along with advanced imaging which help in rapid diagnosis so that the ailment can be treated on time.¹¹

What is angina swollen tongue?

Angina Swollen Tongue is the condition in which there is a bacterial infection of the skin below the tongue specifically in the region associated with the salivary glands below the lower jaw that results in the swelling of the tongue. It is also known as Ludwig's angina. It causes difficulty in swallowing saliva and even difficulty in breathing due to airways obstruction.¹² It is a curable condition, no need to worry about it, as its mortality rate is less than 8% due to surgery techniques and effective antibiotics.¹³ The reason for calling this condition angina swollen tongue is due to its origin from cardiac pain. This condition is more common among males as compared to females. It usually affects individuals around 20 to 60 years of age. It is less common among children.¹³

Signs and symptoms: 

Most common symptoms are increase in the temperature of the body above the normal range which is 37 °C, fatigue, weakness, inflammation, swelling of the tongue and neck due to fluid filled in the tissues of the neck and tongue, painful tongue movement, stiffness of jaws, immobility of jaw (lockjaw) and difficulty in swallowing saliva. More severe symptoms are shortness of breath, feeling of suffocation due to tightening of air-passage. Lack of oxygen can result in mental changes and difficulty in speaking. As it is a bacterial infection so it can cause a rapid heart rate. If a bacterial infection is not treated it can even cause swelling of bones.¹³

Figure 1: On right side internal organs are showing which are swollen and infected and on left side appearance of swollen chin is shown.⁷

Causes:

Poor dental hygiene causes the accumulation of too many bacteria in your mouth if you don't brush and floss regularly. Additionally, it may result in tooth infections, gum disease, and more frequent dental procedures. The submandibular space is a space in the jaw that is located beneath the roots of your teeth. An infection can occur if bacteria from the roots of the teeth enter this space as a result of dental work or gum disease. That's why poor dental hygiene is considered the major cause of angina swollen tongue. Dental procedures pose a risk due to the possibility of the release of harmful bacteria after a minor abrasion to the gum tissue. angina swollen tongue is more common in people with weakened immune systems, such as those who have HIV, or who take medications that suppress the immune system.⁷ Usually, a bacterial infection under the tongue, on the floor of the mouth which causes angina swollen tongue develops after infection of the tooth roots and frequently occurs following a mouth injury.¹⁴ The infection begins in the lower jaw's second or third molar in nine out of ten cases and quickly spreads to the tongue and throat in angina swollen tongue.¹⁵

Risk factors

• Injured or broken jaw, cracked tooth, Poor oral hygiene, Weakened immune system, and Tongue piercings are risk factors of angina swollen tongue as they promote bacterial infection in the mouth and angina swollen is caused by the bacterial infection in the mouth¹⁵
• Dental procedures cause minor trauma to the gum tissue, which can result in the release of harmful bacteria increasing the risk of angina swollen tongue⁷

How to diagnose

Based on your symptoms, your doctor can diagnose the ailment of angina swollen tongue. A CT scan may also be performed.¹⁵ Your doctor will examine your neck and head to look for swelling and redness under your chin in the upper neck as shown above in figure 1 on the left side. The swelling may reach the mouth's floor. It is possible to send a sample of the tissue's fluid to the laboratory for bacteria testing to confirm the presence of bacteria responsible for angina swollen tongue.¹⁴

Treatment

At early detection, antibiotics can be used for clearing up the bacterial infection. If the condition worsens and the patient feels difficulty in breathing then emergency care is provided in which a breathing tube is placed through the nose or mouth into the lungs for restoring breathing (intubation). Surgery can be used to aid breathing. In surgery (tracheostomy) an opening is created into the windpipe of the patient through the neck.¹⁴ Surgery is mostly left as the last option of treatment when the patient is not showing a positive response to antibiotics or intubation.¹⁰

Complications

Complications might include airway blockage, life-threatening generalized infection damaging the body’s own tissues (sepsis), and a fatal drop in blood pressure causing shortness of breath (septic shock).¹⁴ Other complications are aspiration pneumonia, carotid arterial rupture (carotid arteries provide blood supply to the neck and head, rupture of carotid arteries disrupt the blood supply to the neck and head) and obstruction of the airway.⁹

Home remedies

Angina swollen tongue is caused by the bacterial infection; reducing bacterial infection by home remedies can be beneficial for the angina swollen tongue. Applying aloe vera or honey to the infected tongue can help in reducing bacterial infection as both possess antibacterial properties. Rinse your mouth several times a day by using aloe vera juice. Gargling with salt water can reduce pain and swelling of the tongue. You can rinse your mouth using a mixture of baking soda and warm water for reducing the swelling of the tongue.¹⁷

Medications

The antibiotics that are prescribed most frequently are clindamycin or ampicillin-sulbactam. Cefepime, meropenem, and piperacillin-tazobactam antibiotics are a few other options.¹⁶ The antibiotics typically last for two weeks. Fever and the number of white blood cells need to be closely monitored.

Preventions

The tooth infections that cause Ludwig's angina can be prevented with good oral hygiene and regular dental visits. If you're experiencing mouth sores, toothaches, or other oral issues, don't put it off any longer.¹⁵ For routine checkups, go to the dentist. Immediately to treat mouth or tooth infection symptoms.¹⁴

When to see a doctor

If you observe the occurrence of the following issues then see a doctor

• Trouble in swallowing or breathing¹⁵
• Pain, burning sensation, swelling and redness of the tongue¹⁵
• Swelling and pain in your cheek, neck or jaws¹⁵

Summary

Angina swollen tongue began with bacterial infection of the mouth surface resulting in the swelling of tongue and causing difficulty in swallowing and breathing. Complications are like blockage of airways and aspiration pneumonia. Infection can spread to the neck and cause swelling of the neck resulting in shortness of breath. Antibiotics can be used for controlling the spread of infection and if the infection worsens then a breathing tube can be inserted into the lungs to aid breathing. In more severe conditions surgery can be performed for removing the infection.