Brush up your knowledge on retained deciduous puppy teeth

Figure 1. Soft tissue trauma caused by malocclusion

A thorough oral examination  is an integral part of all puppy health checks, starting from that very first visit. For many puppy owners, issues such as retained teeth are simply not on their radar, or at least feature fairly low down their priority list. However, retained deciduous teeth in puppies may lead to malocclusion, and preliminary results from one study1 suggest that up to 20 percent of puppies have malocclusion that causes soft tissue trauma and pain (Figure 1).

Normal puppy dentition

Full deciduous dentition should be present buy the time a puppy is 12 weeks old, and at seven months, this should have been replaced by permanent teeth (Table 1). A deciduous tooth is described as retained, if it is not shed when the permanent tooth erupts (Figure 2).

Figure 2. Retained maxillary canine tooth
 Deciduous teethPermanent
Incisors21 – 28 days3 -5 months
Canines21 – 23 days4 – 6 months
Premolars28 – 84 days4 – 6 months
Molarsn/a5 -7 months
Table 1. Timing of eruption of deciduous and permanent dentition in dogs

Why should puppy deciduous teeth be removed?

Leaving retained deciduous teeth in situ can result in a number of problems including:

  • Interference with permanent dentition, increasing the risk of malocclusion
  • Trapping of food, leading to gingivitis and periodontitis
  • Prevention of normal jaw growth

When should retained deciduous puppy teeth be removed?

In most cases, retained deciduous puppy teeth should be removed as soon as they are identified. Neutering rarely coincides with the point at which puppy milk teeth require surgical removal and extractions should not be delayed until this time – this is especially so in larger breeds which may be neutered later. Leaving surgical extraction until neutering risks prolonged oral pain and may also increase the risk of problems with the permanent dentition, such as malocclusion.

Top tips for extraction of retained deciduous teeth in puppies

  1. Use an open extraction technique

Elevate a mucoperiosteal flap and remove the buccal bone over the tooth root (Figure 3). The root of canine teeth can be at least twice the length of the crown. Good exposure will decrease the risk of root fracture and other complications.

2. Avoid the use of elevators or luxators on the lingual aspect of the tooth

The bud of the adult canine tooth sits in a lingual position to the deciduous canine. Contact with the tooth bud can cause damage to the permanent tooth, including enamel defects.

3. Patience, patience, patience

The luxator should be used to slowly stretch and break down the periodontal ligament. Only when the tooth is truly mobile,  should the tooth be carefully removed from the alveolus using extraction forceps (Figure 4).

4. Allow enough time

The extraction of puppy deciduous canine teeth is challenging, and sufficient time should be allocated on busy ops lists – 30 minutes per tooth is the minimum.

5. Post-operative radiography

Dental radiography to confirm complete extraction is advisable.

Malocclusion in puppies: lingually displaced canines

The lingual displacement of mandibular canine teeth is one of the most common malocclusions seen in puppies, and this is primarily as the result of retained teeth. If deciduous teeth are lingually displaced they may…

  • Cause trauma to the soft tissues of the palate
  • Lock into the hard palate, causing pain and affecting the growth of the mandible
  • Cause lingual displacement of the permanent tooth too

Where deciduous teeth are lingually displaced it is important that extraction is performed as soon as possible, and certainly before the eruption of permanent teeth.

Why do puppy deciduous teeth matter?

Several factors have caused deciduous tooth management to become a more discussed issue recently:

  • Increase in brachycephalic breeds: Due to skull conformation, these breeds have a higher incidence of overcrowding and more potential for retained teeth.
  • Pandemic puppies: Less experienced breeders and indiscriminate breeding to meet the demand for pandemic puppies may have resulted in more puppies with less than perfect dentition. It has also been suggested that popular poodle crosses may be predisposed to dental conditions.
  • Crowded puppy consult agenda: During puppy consults, there is a lot to discuss including neutering, pet health clubs, parasite control and nutrition. It can be difficult when under time pressure to always make sure that dentition and dental care is fully addressed.

VisioCare Services – improving communication and compliance

Puppy owners are often fearful of the potential adverse consequences of anaesthesia and may be reluctant to commit to the remedial dental interventions required. Taking the time to inform owners of the potential consequences of untreated retained deciduous teeth in puppies, can help to overcome these barriers, and that’s where VisioCare comes in…

VisioCare Services provides a range of digital communication tools for veterinary practices, including waiting room TV, and a library of explainer clinical animations and videos to use in the consulting room.

60% of owners say they would find it useful for animations and digital images to be used to explain procedures and conditions, rather than words alone

84% want clearer communication on their pet’s treatment plan

VisioCare state-of-the-art images and animations help to:

  • Increase client understanding of conditions and overall treatment compliance
  • Improve animal welfare by optimising communication and condition management
  • Save time for vet professionals and increase customer satisfaction and loyalty, thereby reducing associated stress

Interested in accessing a full range of dental images including tooth eruption animations? Get in touch today to support communication and help your clients understand complex diagnoses and treatment plans.


  1. Visiocare Puppy Tooth Census (2022)

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