Warning: This report contains graphic descriptions and images that may be disturbing to some

It’s not often that bad breath is enough to send a person to hospital. But that’s what happened to one man whose breath had become so intensely awful that his wife couldn’t stand it any longer and ordered him to get to a doctor.

The Toronto-area man had been experiencing mouth pain for about a week before the smell began. After arriving at his local emergency room, nurses suspected he had some kind of oral abscess and asked ER physician Dr. Raj Waghmare to take a look.

Waghmare recently recounted the unusual case on his blog, ERTales.com. He writes that the patient, in his mid-30s, came into his emergency room six months ago saying he had been experiencing problems under his tongue for years.

But in the last week, a swollen lump had formed -- not altogether unusual, since lumps often formed there then went away after a few days, he explained.

But the intensely bad breath? That was new.

Waghmare asked to look under the man’s tongue and noticed what looked like the whitehead of a pimple poking out of one of his saliva ducts. There was also the putrid smell, one that Raghmare said reminded of “the putrid pungence of blue cheese.”

It turned out the man had a “sialolith“: a salivary duct stone. It's a buildup of minerals and salts in one of the ducts leading out the saliva gland under his tongue. The blockage prevents saliva from exiting the duct, allowing bacteria to build up and leading to a smelly infection.

“(The stone) could have been there for 20 years but was never big enough that it was blocking anything,” Waghmare explained to CTVNews.ca. “He said there were times where it would swell up and move a little. And then it would clear and the saliva would be able to pass through.”

Waghmare had to extract the blockage – but first he needed to put two masks around his mouth and nose because “the stench was just really gross.”

Using forceps, he was able to pull the stone out in one piece -- a process he says that was perhaps a bit uncomfortable to the patient.

“It definitely didn’t feel good for him,” Waghmare said. “He was definitely grimacing.”

The stone turned out to be huge, as the photo and video show. Other case reports about saliva duct stones have reported stones smaller than 10 millimetres; some have been larger than 15 mm.

This one was 23 mm long. A giant, by medical standards.

“It’s pretty rare for them to present in the ER at all,” Waghmare said, noting that it’s dentists who usually discover salivary duct problems.

“And certainly ones that big -- I don’t think I’ll ever see one again,” he said.

Waghmare was so fascinated by the stone, he placed into a urine specimen cup and showed it off to as many colleagues as he could find. He had to warn them, though, not to open the lid; the smell was too intense.

“I was carrying it around for the whole shift and saying, ‘Hey check this out,’ It was just pretty neat,” he said.

Saliva duct stones are “exceedingly rare,” Waghmare said, and it remains a mystery why they form at all. With so few patients to study, there simply isn’t much research on them.

As for the patient, his discomfort and bad breath were instantly relieved and he was sent home. The stone itself was sent off to the hospital’s pathology department, just like all things extracted in the ER are.

Since posting about the case on his blog, ERTales.com, Waghmare says he’s received lots of feedback. Most comment about how disgusting the story is, but Waghmare doesn’t see it that way.

“It’s actually not one of the things that we would consider disgusting in the ER. There are many, many more disgusting things than that,” he said.