Should I worry if my puppy breaks a tooth?

I see a lot of puppies during the teething stage and luckily it’s pretty rare that I see a puppy who has broken a tooth. Puppies chew everything during the teething stage.  If they bite vigorously on something too hard, tug with vigor on a toy, or get into a scuffle, they risk fracturing a tooth.  A puppy’s primary (or baby) teeth are more delicate than the adult teeth and are at increased risk for fracturing. 

A broken tooth needs to be extracted if the pulp chamber is exposed. The pulp chamber is the central part of the tooth where the blood supply and nerve is located. A closed fracture (like a tip fracture of the fang tooth) does not need to be extracted. If your puppy breaks a tooth and exposes the pulp chamber that tooth is at risk for infection.   

Puppy teeth

Puppies have 28 teeth that are called “deciduous teeth”.  Like deciduous trees that shed their leaves, puppy baby teeth will be replaced by 42 adult teeth within their first 6 months of life.  Your puppy will be starting the process of shedding their baby teeth by 12 weeks of age to make room for the adult teeth to move in. Puppies love to chew and if they chew or pull too hard on a toy, they risk breaking a tooth.  Puppies’ primary teeth are smaller and thin walled which makes them much more delicate.  Anyone who’s played with a puppy has probably noticed that the canine teeth in puppies are very long and have sharp needle-like projections. Anecdotally in practice, the most commonly fractured tooth I see in puppies is their upper canine tooth. When a puppy fractures their tooth, that tooth does not repair itself or grow back.  There should be, however, an adult tooth waiting to replace it. 

The blue arrow in the X-ray above is pointing to the baby canine tooth.  You can see how slender and thin the tooth is.  The larger tooth above (green arrow) it is the newly erupted adult canine tooth. 

Open versus closed tooth fractures

The picture above is a diagram of a dog’s tooth from.  The flame-like center of the tooth is composed of the pulpal chamber and the root canal. The pulpal chamber is the center of the tooth that houses the blood supply to the tooth and the nervous tissue within the tooth.  The outer layer of the tooth is the enamel and hard outer layer is the dentin which is hard like bone.  If the tip of the canine tooth is fractured but is above the pulp chamber, that is considered a “closed” fracture. Closed fractures are not a risk to the dog, but do put the tooth at increased risk for further deterioration or breakage that may eventually expose the pulp chamber. If a tooth is fractured to expose the pulp chamber, then that puts the tooth in immediate risk of infection and is considered an open fracture.  Open fractures are painful as the nerve of the tooth is exposed.  

If the pulp chamber is exposed to bacteria (and there is a lot of bacteria in the mouth) the tooth can become infected and the pulp will deteriorate.  Once the pulp has deteriorated, the tooth will no longer be painful, but the infection can spread to the tissue surrounding the apex of the tooth root and may even damage the developing adult tooth bud. Dead or unhealthy teeth look pink in color first and then turn gray. 

Although tetanus is rare in the dog, there are numerous reports of puppies contracting tetanus from an initial tooth fracture.  

How do you know a tooth is injured?  

You may not be able to confidently tell if your puppy broke off a portion of his canine tooth, or you can see some of it is missing compared to the other canine tooth- but you don’t know if the fracture is considered open or closed. 

What are some clues that will tell you to bring your puppy in for an evaluation by your veterinarian? 

Any tooth discolored pink or brown is a concern.  When a tooth is initially damaged, the injured and inflamed pulp may turn the tooth pink in color.  As the pulp tissue becomes infected and starts to die, it may turn the tooth brown or gray in color. 

The picture above shows an obvious open fracture at the base of this puppy’s canine tooth.  The pink center is bleeding from the pulp chamber (center) of the tooth.  

You can see another tip fracture of this canine tooth.  The tooth has turned brown and black from infection.  The tooth is no longer a viable or living tooth and should be extracted. 

The photo above shows a normal sulcus or divot left behind when a tooth is shed in a normal manner. 

Most fractured puppy teeth will leave a remnant of tooth material in the gum line where the remaining crown is attached to the root. If you don’t see that, most likely the tooth that fell out was shed normally. The baby teeth start to resorb the roots and this resorption causes the tooth to loosen so that it can fall out. Puppy teeth fall out often without much root material attached. If you see some bleeding after a tooth falls out, this can be normal for a tooth that is falling out . Blood does not necessarily mean that the tooth that came out was broken when it fell out. Most owners actually do not find their puppy’s baby teeth  because they are swallowed. If you see a baby tooth that is wiggly, it is not advisable to try to pull it out.  Leave it alone and let mother nature take care of the process.  

What happens if you decide to wait several weeks until your puppy is old enough to be spayed or neutered to treat the broken baby tooth? 

The bottom line is that you are risking infection to the broken tooth.  This infection will rarely cause serious systemic illness, but a rare infection with tetanus could be life threatening. 

More likely, you risk local infection of the tooth and surrounding tissues that  can cause damage to the developing adult tooth behind it.  A broken tooth is also painful and waiting to remove it will delay treating a painful mouth. 

Although most people do not want to put their puppy through an additional anesthetic event prior to their spay or neuter, the consensus of veterinary dentists is that early extraction of a fractured baby tooth will provide the best care for your pet and overall outcome. 

Removing a baby tooth is a more challenging procedure than removing most adult teeth due to how thin walled the bay teeth are.  An inelegant extraction that nicks the developing adult tooth behind the baby tooth can risk damaging this developing tooth. 

An example of damage caused to the  adult lower canine tooth is a focal defect in the enamel (the protective shiny outer layer of the tooth).  This looks like brown discoloration on the adult tooth. 

How to care for puppy teeth?

Given how delicate puppy teeth are, some veterinary dentists do not recommend brushing your puppy’s baby teeth.  They cite increased risk for damage to the delicate tooth and possible discomfort as their mouth may be sore from the process of their adult teeth erupting. 

Tooth brushing is definitely recommended for the adult teeth as regular dental care is an essential part of maintaining good oral health for your dog. You can still practice with your puppy by regularly opening their mouth and having them lick dog toothpaste. 

The brand of toothpaste for dogs I like best is Petsmile. This toothpaste works even when you cannot brush the paste on the teeth. So, if your dog won’t give you much time , this product still if effective at breaking down plaque and preventing hard tartar. It is approved by the Veteirnary Oral Health Council (VOHC). The VOHC has a list of approved and clinically tested oral health products for dogs that you can view here.

Chew toys should be selected carefully.  According to Fraser Hale DVM, FAVD (a board-certified veterinary dental specialist), owners should follow the knee-cap rule when selecting a chew toy for their puppy: if you don’t want to be hit in the knee cap with the chew toy, then it’s too hard for your dog to chew. 

Specifically he warns against the following chew items: 

Having a puppy is a lot of fun but teething is probably the most frustrating part.  Luckily, teething lasts only for a short while.  Provide the right teething toys and enjoy time with your little one!