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Welcome to Shree Sai Dental hospital.( Nallakunta / Shankarmatt.)

The new millennium has begun with the century of globalization. At Shree Sai Dental Clinic, we are changing the way people feel about the revolutionary developments of dentistry. We pride ourselves on delivering dental services to our patients which are matching with international standards. The interest and excitement surrounding esthetic dentistry has added a new dimension to our hub. New widespread public awareness has created a demand for superior esthetic results and is a primary motivating factor for patients seeking dental care.

It is no longer possible for a single specialist to handle the esthetic and functional demands of the patients and interdisciplinary approach has gained wide acceptance. Our practice is committed to provide comprehensive dental care with an emphasis on smile restoration employing the latest cosmetic dentistry procedures including dental implants, porcelain veneers, porcelain crowns and bridges, teeth whitening and composite white fillings. Whether you are looking to subtly enhance your smile or are in need of more extensive dental work, contact us today and we will be glad to help. We rediscover Ur Smile!

Our dental practice offers a full range of first class dental services, from Cosmetic Dentistry procedures including porcelain veneers, porcelain crowns, correction of irregular and crooked teeth (braces – metallic/ceramic), bonding and teeth whitening, to restorative procedures such as dental implants and bridges. We specialize in full mouth restorations employing the latest technology and techniques available to give our patients outstanding results.

We have made dental care more convenient by providing high quality cosmetic dental treatments at fees that are easy on the pocket. We welcome you to experience the satisfaction, growth and professional status that our center has to offer and look forward to meeting you!

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Ludwigs Angina



It is defined as the acute toxic swelling with bilateral involvement of the sublingual,submandibular,and submental spaces.


It is a distinct clinical entity known since the time of Hippocrates.
It was first described by ‘Wilhelm Friedrich Von Ludwig’
But the name was coined by ‘Cramer’ in 1837 who presented cases which include classical description of entity by W.F.Ludwig.

1.Odontogenic infections:
a.Acute dentoalveolar abscess
b.Acute periodontal abscesss
c.Acute pericoronal abscess
most commonly teeth involved are mandibular second & third molars
2.usage of contaminated needles
3.traumatic injuries of orofacial regions
4.submandibular & sublingual sialadenitis
5.secondary infections of oral malignancies

Constitutional features like pyrexia ,anorexia,chills and malaise.
Patient looks toxic very ill and dehydrated.

1. Swelling develops and spreads rapidly involving submental & submandibular lymph nodes bilaterally which soon extends into the anterior part of the neck into the clavicles.
2. It is described as the brawny, non-pitting, non-fluctuant swellingassociated with severe tenderness.
Classically it shows ill defined borders with induration.
3.Because of its location ,the floor of the mouth and tounge becomes elevated causing difficulty in breathing.
4. in extreme cases tounge may actually protrude from the mouth and its movements are reduced.
5. deglution and speech may also become difficult.
6. saliva may drool from the mouth.
7. this situation may be compounded by the edema of glottis causing  STRIDOR which is the alarming sign of this fatal extension needing emergency intervention.
8. signs and symptoms of respiratory obstruction:
a.increased respiratory rate
b.breathing being shallow with use of accessory muscles of respiration.
c.dilation of external nares
d.raising of thoracic inlets
e.indrawing of tissues above clavicles
f.cyanosis may be seen because of the progressive hypoxia.

It is a diffuse inflammation of soft tissues which is not circumscribed to one area in contrast to an abscess.
Usually caused by microbes which produce hyaluronidases and fibrinolysins which break tissue continuity.

A plethora of microbes were identified as the causative organisms.
Streptococci the potent producers of hyaluronidase are always associated with classical ludwigs angina.
While the others are
-Gram negative entric organisms like..e.coli, pseudomonas.
Anerobes like..bacteriods(B.melanogenicus, B.oralis, B.corrodense).


 1.   General medical examination
 2.   Evaluate laboratory data for blood count, haemoglobin and proteins.
 3.   Pus samples sent for culture.
 4.   Chest radiograph to rule out pneumonia

 a.   Early diagnosis
 b.   Maintanence of patent airway
 c.    Intense and prolonged antibiotic therapy
 d.   Extraction of offending tooth/teeth
 e.   Surgical drainage or decompression of fascial spaces
 Commonly used antibiotics:




It is by surgical decompression. The advantages of early surgical intervention are:
a. reduces pressure of the edematous tissue on the respiratory tract.
b. allows samples and specimens for culture and lab diagnosis.
c. allows for the placement of the drains
d. allows prompt drainage.
Following  adequate  anesthesia bilateral sub-mandibular  incisions and if required a midline submental incision  1cm below the inferior border of mandible are sufficient to drain the spaces.
                                  To be effective it is essential to divide deep fascia and mylohoid muscle, then only it will drain sublingual space.
In most of the cases of the ludwig’s angina little or no pus can be drained by surgical intervention.But,in later stages or during post-operative period profuse pus may be seen draining.
Care should be taken to prevent injury to following:
1.   Facial vessels near angle
2.   Lingual nerve
3.   Jugular vein laterally below angle region.

Apart from this patient should be hydrated because he might be dehydrated because of the following reasons:
1.   Diminished liquid intake due to dysphagia
2.   Due to toxic nature of the condition there might be excessive urination and perspiration with elimination of body fluids.

a.   Osteomyelitis
b.   Maxillary sinusitis
c.    Localized respiratory tract disturbances
d.   Digestive tract disturbances
More serious complications include:
e.   Septicaemia
f.      Mediastinitis
g.   Neurological complications
h.   Cavernous sinus thrombosis
i.      Brain abscess
j.      Death…if untreated with in 12-24 hours after acute attack  due to asphyxia.

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