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If your puppy has an adult tooth coming in beside a baby tooth that hasn't budged, don't wait to see if it falls out. Book the extraction. The old advice was to hold off until the spay or neuter at six months, and the veterinary dental literature no longer supports it. Two teeth in one socket start causing problems within weeks, not months.
Key Takeaways
Book an exam this week if: you can see an adult tooth and a baby tooth in the same spot, the lower adult canine looks like it's pointing at the roof of the mouth, the gum between two teeth is red or smells bad, or your puppy is dropping food or chewing on one side. A lower canine striking the palate is painful and shouldn't wait. Book online or call (519) 896-0532.
A retained puppy tooth is a baby tooth still sitting in place after the adult tooth beneath it has started to come through. You end up looking at two teeth where there should be one.
Puppies are born without teeth. The baby teeth, also called deciduous teeth, start erupting at three to five weeks of age, and most puppies end up with 28 of them.2
Around four to five months, the adult teeth start pushing up. All 42 should be in place by seven months.2
Here's how it's supposed to work. The adult tooth presses against the root of the baby tooth, that root dissolves, and the baby tooth drops out on its own.
The problem starts when the adult tooth erupts in the wrong position. It misses the root, nothing dissolves, and the baby tooth stays firmly put.1
Your vet may call it a persistent deciduous tooth. That's the more accurate term. The American Veterinary Dental College reserves "retained" for a baby tooth that never erupted at all, which is a different problem.6
Not long at all. Once you can see the adult tooth erupting next to a baby tooth that hasn't loosened, that baby tooth needs to come out.1,3
Merck puts it plainly. A deciduous tooth should be extracted once its adult successor has begun to erupt.1
Dr. Cindy Charlier, a board certified veterinary dentist, goes further. Waiting to see if the tooth falls out on its own isn't an appropriate treatment decision, and as little as two weeks of overlap can leave a permanent defect in the bite.3
| Puppy's age | What's normal | What I'd do |
|---|---|---|
| 3 to 5 weeks | Baby teeth erupting, 28 in total2 | Nothing yet. Get your puppy used to having their mouth handled. |
| 8 to 12 weeks | Full set of baby teeth | Have us check the mouth at each booster visit |
| 4 to 5 months | Adult incisors and canines start coming in2 | Look in the mouth weekly. This is when doubles show up. |
| Any age, two teeth in one spot | Not normal | Book an exam. Don't wait for it to resolve.1,3,4 |
| 7 months | All 42 adult teeth in, no baby teeth left2 | Any baby tooth still there is overdue |
Every puppy runs on their own clock, and a week either side of these numbers is fine.
What isn't fine is leaving two teeth in one socket while you wait to see what happens.
The baby tooth is occupying the spot the adult tooth is meant to take. So the adult tooth comes up wherever it can, which is usually the wrong place.
Upper adult canines erupt in front of their baby counterpart. Lower adult canines erupt on the tongue side.3 Leave the baby tooth sitting there and the adult tooth gets pushed further off course.
Once the jaw finishes growing, that position is set. Correcting it later means orthodontics or crown reduction, and both are far bigger jobs than removing a baby tooth at four months.
Two teeth crammed into one socket leave a gap that food and bacteria pack into. Merck notes that this crowding predisposes the area to periodontitis.1
You can't clean a space that narrow, and neither can your puppy's tongue.
Starting life with gum disease is a poor start for a mouth that has to last 14 years. There's more on how we treat and prevent it on our pet dentistry page.
This is the one I least like to see. When a lower baby canine stays put, the adult canine gets pushed toward the tongue and can end up striking the roof of the mouth.
That hurts. Left alone, it can wear through into the nasal cavity and create an opening between the mouth and the nose.3
Baby canines can also lock the lower jaw against the upper one and stop it growing at its own rate. That's called dental interlock, and it can affect how the whole jaw develops.4
Extraction, under general anesthesia. There's no way around the anesthetic, and I wouldn't want one done without it.
A baby canine root is roughly twice the length of the crown you can see. It has to come out in one piece, so this is a surgical extraction rather than a quick pull.
Your vet should take dental x-rays first and use a local nerve block.3 The developing adult tooth next door has thin dentin, a large pulp chamber and an open root tip, which makes it easy to damage with rushed technique.3
Most puppies go home the same day and eat dinner that night. Every one of ours goes home with pain medication. More on how we handle anesthesia is on our anesthesia and patient monitoring page.
No, and this is where my advice has changed.
Bundling the extraction into the spay or neuter at six or seven months saves an anesthetic, and for years that's how many of us handled it. The trouble is that the damage happens while you're waiting.
Dr. John Lewis, another board certified veterinary dentist, sets the standard plainly. Persistent deciduous teeth should be extracted before they cause misalignment of their permanent counterparts.4 If the adult tooth is erupting at four months and the neuter is three months away, that's three months of a tooth being shoved off course.
There's a real counterweight here, and I'd rather you hear it from me. A 2024 study in Frontiers in Veterinary Science followed 74 puppies who had lower baby canines removed between 8 and 12 weeks of age. Enamel defects turned up on the adult tooth in 17.5% of them.7 Going in very early carries its own cost.
So the rule isn't "sooner is always better." It's "as soon as the adult tooth is erupting," which for most puppies lands between four and five months. That's the window where the baby tooth is clearly overstaying and the adult tooth is developed enough to work around safely.
If your puppy is already booked for a spay or neuter and the timing happens to line up, we'll gladly do both under one anesthetic. What I wouldn't do is delay the extraction to make that happen.
Small breeds, and the smaller the dog the worse it gets.
Yorkshire Terriers, poodles and Dachshunds are the breeds named most often in the literature, along with toy breeds generally.3,4 In our practice I'd add Chihuahuas, Pomeranians and Maltese to that list.
There's good data on how lopsided this is. A 2023 study followed 61 Yorkshire Terrier puppies and found 69% had at least one persistent tooth. Among the puppies under 3 kg, 89% had a retained canine. Among those over 5 kg, it was 12%.5
Canines are the tooth most likely to hang on, ahead of premolars and incisors.1,5
It also runs in families. Merck notes that most persistent deciduous teeth are genetic, and that affected dogs shouldn't be bred unless the cause is known to be trauma.1 Worth knowing if you're planning a litter.
I'll look at the whole mouth, not just the obvious double tooth. Puppies often have more than one.
I'll check how the bite lines up, whether the lower canines are contacting the palate, and how far along the adult teeth are.
If extraction is the plan, we'll book it and take x-rays on the day. Bring your puppy in hungry, since they'll need an empty stomach for the anesthetic.
Photos help more than you'd think. If you noticed the double tooth a few weeks ago and took a picture, bring it. It tells me how fast the adult tooth is moving.
Puppy visits are a good time to catch this anyway. Boosters run roughly monthly through the first four months, so we're already looking in the mouth regularly during puppy wellness visits. While you're in there, small pink lumps on the gums or lips are usually oral papillomas, which are common at this age and rarely a problem.
Retained puppy teeth are common, they're straightforward to fix, and the fix works much better early than late. If you can see two teeth in one spot and you're in Kitchener, Waterloo or Cambridge, book an appointment or call us at (519) 896-0532.
Sometimes, a retained puppy tooth might still be a bit wobbly, giving hope that it might eventually fall out on its own. While this can happen, it's not something to rely on, especially if the adult tooth has already erupted significantly.
Ignoring retained puppy teeth can lead to several dental problems. These include:
- Crowding and misalignment of adult teeth, leading to bite issues.
- Increased risk of periodontal disease due to trapped food and bacteria.
- Difficulty maintaining proper oral hygiene, contributing to plaque buildup and tooth decay.
- Potential irritation or discomfort for your dog.
Rest assured, your puppy's comfort is a top priority during dental procedures. Extractions are performed under general anesthesia, ensuring your pup is completely asleep and feels no pain. We also provide pain medication after the procedure to ensure a smooth recovery.
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