DEFINITION/OVERVIEW
- An offensive odor emanating from the oral cavity
ETIOLOGY/PATHOPHYSIOLOGY
- The sour milk odor accompanying periodontal disease may result from bacterial populations associated with plaque, calculus, unhealthy tissues, decomposing food particles retained within the oral cavity, persistent bleeding due to coagulation abnormalities, or from tissue necrosis
- Contrary to common belief, neither normal lung air nor stomach aroma contribute
- The most common cause is periodontal disease caused by plaque: bacteria are attracted to an acellular film formed from the precipitation of salivary glycoproteins (the pellicle)
- A bacterial biofilm forms over a freshly cleaned and polished tooth as soon as the patient starts to salivate; bacteria attach to the pellicle within 6–8 hours; within days, the plaque becomes mineralized, producing calculus upon which more plaque accumulates; as plaque ages and gingivitis can progress into periodontitis (bone loss), the bacterial flora changes from a predominantly nonmotile gram-positive aerobic coccoid flora to a more motile, gram-negative anaerobic population including Porphyromonas, Bacteroides, Fusobacterium, and Actinomyces
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