Phlegmone a.k.a. Ludwig angina

This time I’m gonna blabber little about mouth

It has a space, filled with lots of components –

· Air- the gases (O2, CO2, & the rest)

· Liquid, - the saliva

· Solids – all the mouth’s main component – teeth, cheek, gum, tongue, palate, even the microbes!

Mature permanent teeth

These are some of microbes found in our mouth – found especially at teeth, gum, & surrounding:

· Bacterias

Gram (+)	· Streptococcus	· S. mutans · S. salivarius; S. vestibularis · S. constellates; S. anginus · S. mitis; S. sanguis; S. gordonii; S.oralis; S.crista · Peptococcus anaerobius; Peptococcus micros
	· Stomacoccus	· S. mucilagenous

Even microbes need food (the leftover stuck at between teeth- especially food that rich with sucrose) & shelter (that is the tooth & the environment) to live. IF their food is way much more than enough, then the population will grow, causing more space to be used, & much more waste produce – the ‘waste’of the microbs causing the tooth involve become erode because it is acidic. The acidic waste also killed most of the normal flora, & let the new population (the one which can stand in acidic condition) to grow & dominate.

The more the tooth were left untreated, the bigger the hole at the tooth, & the bigger the hole, the deeper the microbes can invade the tooth. The invasion will create pus within the area of invasion

At the same time, the tooth itself actually do trying it best to regrow by undergoing the recalcification process (process of building the tooth's structure). Anyway, the decalcification process (process of destroying the tooth's structure) overcome the recalcification process. That is why there's a white chalky thing within the destroid tooth.

Route used by microbes to invade the periapical & pulp

To makes things worse, the pus may spread into the jaw's environment (depend on which tooth was invaded). The outspread invasion occurs when one's teeth hygienes is really bad (either he/she cannot afford to buy a toothpaste, or really is a 24 hrs-sugar eater).

At this rate, the person might show up with thick skin & bloated, red, painful cheek & to wider spread - neck. The spit fluid difficult to be swallowed because the neck is painful when swallowing - so the spit end up drooling out of mouth. These signs show the phlegmone a.k.a Ludwig Angina. The worst outcome of phlegmone is death due to breathing difficulty (since the neck part were badly inflammed, & cause lots of fluid formed, & accumulate at airway part (at neck)).

references:
Pictures - Essentials Microbiology for Dentistry, Samaranayake, 3rd ed.