Signs of tooth pain in dogs:how to tell and what to do

Why a dog keeps eating even though its teeth hurt

“If it hurt, she wouldn’t eat.” Because of this belief, dogs often reach a dentist late. Dental pain usually builds up gradually, and the dog has time to adapt: it takes food on the healthy side, picks softer things and chews less. The drive to eat is stronger than discomfort, and dogs are not inclined to whine about chronic pain.

There is also something particular to dogs: many of them swallow kibble almost without biting it in the first place. So an empty bowl says little about the teeth. Far more telling is what happens with toys, chews and anything the dog really has to bite through. More on this in Why pets keep eating with painful teeth.

Tooth pain is real: every tooth has a pulp with a nerve, and the signal travels to the brain. I show how this works on a diagram in How a dog’s and cat’s mouth works.

How to tell if your dog’s teeth hurt: the signs

Each sign on its own can have another cause. But if you see two or three at once, or they last longer than a few days, the mouth should be checked by a vet.

Pay particular attention to swelling on the cheek, under the eye or along the lower jaw: this happens when infection from a tooth root spreads into the bone. In small dogs, sneezing and discharge from one nostril can mean an oronasal fistula — an opening between the mouth and the nose caused by periodontal disease around an upper canine.

What most often hurts in dogs

One dog can have several problems at once, so at the examination I do not look for a single “culprit” — I assess the whole mouth. These are the most common sources of pain.

Broken canines and the big upper cheek tooth

Dogs break teeth on bones, antlers, hooves, hard nylon toys, stones and cage bars, and in knocks and fights. The teeth that suffer most are the canines and the upper fourth premolar — the largest tooth in the upper jaw, which the dog uses to crack hard things (it is also called the carnassial tooth). A slab often breaks off its outer surface: from outside it looks like a small chip, but the fracture line often runs under the gum.

If you see a pink, red or dark dot in the centre of the fracture, that is exposed pulp — the living tissue with nerves and blood vessels inside the tooth. Such a tooth hurts; over time the pulp dies and infection spreads into the bone around the root. The tooth will not heal on its own. More in the articles on pulpitis and what to do if your dog breaks a canine.

Worn teeth can hurt too. Dogs that chew tennis balls or cage bars for hours gradually wear down their crowns, and if a tooth wears faster than the pulp can protect itself with a new layer of dentine (the hard tissue beneath the enamel), the pulp becomes exposed. I explain what to give instead of risky chews in Which bones are safe for dogs and which break teeth.

Periodontal disease, especially in small breeds

Periodontal disease is inflammation of the tissues that hold a tooth in place: the gums, the ligament and the bone. It starts with plaque and gingivitis (inflammation of the gum margin) and then destroys the bone around the root. Inflamed gums, loose teeth, abscesses and deep periodontal pockets — gaps between the tooth and the gum where bacteria collect — all hurt.

In Yorkshire terriers, Chihuahuas, toy poodles, Pomeranians and Maltese the teeth are crowded, temporary teeth often fail to fall out on time, and there is little bone around the roots. So periodontal disease can start early in these dogs and weaken the teeth quickly. Tartar is not always visible: the main changes happen under the gums. More in Periodontal disease in dogs and Teeth in small dog breeds.

Other sources of pain

Owners do not think of these straight away, but they hurt too:

• Stomatitis. Ulcers on the lining of the cheeks and lips where it touches plaque-covered teeth are very painful and cause strong breath odour. More in Stomatitis in dogs.
• Caries and tooth resorption (TR) — destruction of tooth tissue by bacteria or by the body’s own cells. Dogs get these too; a tooth hurts when the defect reaches the sensitive tissues.
• Stuck objects and injuries. A stick splinter between the teeth or in the palate, or a wound under the tongue: the dog suddenly shakes its head, drools, paws at its face or cannot close its mouth.
• Growths in the mouth. A lump on the gum or palate hurts when the teeth injure it. Only a biopsy — examination of a small piece of tissue — shows what the growth is.

Where to look: breed and age

Any dog can have dental pain, but the typical sources differ:

• Small breeds (Yorkie, Chihuahua, Pomeranian, Russian toy, Maltese): periodontal disease, loose teeth, retained temporary teeth. Watch for bad breath, blood on toys and sneezing.
• Brachycephalic breeds — flat-faced dogs (French bulldog, pug, shih tzu): in a short jaw the teeth are crowded and rotated, food gets trapped between them and plaque builds up quickly.
• Large, active and working dogs: fractured canines and upper fourth premolars from hard objects, fetching sticks and stones and bite work; worn teeth from balls.
• Anxious dogs that chew crates, doors or kennel bars: worn and broken canines and incisors.
• Puppies: while the teeth are changing the gums can be sore, and that passes. But a temporary canine that has not fallen out next to the permanent one, or lower canines pressing into the palate, is a reason for an examination, not for waiting.
• Older dogs: slowing down, sleeping longer and fussiness about food are often put down to age. Sometimes chronic pain from periodontal disease or an old fracture is behind them.

How to check your dog’s mouth safely at home

If your dog is calm, you can look at the teeth yourself. Choose a moment when it is relaxed and use good light or your phone torch. Do not force the mouth open: gently lifting the lip at the side is enough — first one side, then the other. A dog in pain may bite even its owner, so if it growls or pulls away, stop.

If you see nothing, that does not mean the teeth are healthy: some problems hide under the gums and show only on X-rays. A few clear photos are more useful than a long struggle, and you can send them for an online consultation. A step-by-step checklist is in How to check your pet’s mouth at home.

1. 1The gum line. Pink with an even edge. A red line, swelling or blood is a reason for a check-up.
2. 2Plaque and tartar at the gum line. Yellow-brown deposits collect most on the big upper cheek teeth.
3. 3Canine tips and the big upper cheek tooth. Chips, cracks, a pink or dark dot where a tooth has broken.
4. 4Tooth colour. A pink, grey or brown tooth may have a dead pulp.
5. 5Incisors. Are they all there, and are any loose?
6. 6Cheeks, palate and tongue. Ulcers, growths, new dark spots, stuck sticks or bones.
7. 7Face and jaws. Swelling under the eye or along the jaw, asymmetry, pain on touch.

My dog’s teeth hurt: what to do now

Here is what is safe to do today:

1. 01

   Give nothing from your medicine cabinet

   Ibuprofen, naproxen, paracetamol, aspirin and other human painkillers are dangerous for dogs: they can damage the stomach, gut, kidneys or liver. Only a vet should choose pain relief.

2. 02

   Put hard things away

   Temporarily remove bones, antlers, hard treats and toys. Offer softened or soft food at room temperature.

3. 03

   Record what you see

   Note when the changes started; take a few photos of the teeth and a short video of your dog eating and chewing.

4. 04

   Book an examination

   An examination and consultation at the clinic, or an online consultation if you are not in Kyiv. Bring a broken tooth with a pink dot or a swollen face in as soon as possible.

5. 05

   Diagnosis and treatment of the cause

   Under general anaesthesia: examination of every tooth, probing and dental radiography; then treatment as clinically indicated, with local anaesthetic blocks.

How I find the source of the pain

At the examination and consultation I look at the mouth as far as the dog allows, ask exactly how it eats and chews, and draw up a plan. At this stage a broken tooth, inflamed gums or tartar are often already visible. But an awake dog will not let me examine the inner side of every tooth, and probing a painful spot would cause it real distress.

So I make the final diagnosis under general anaesthesia with monitoring, following the COHAT protocol — a comprehensive oral assessment and treatment: examination of every tooth, periodontal probing (measuring the depth of the pockets around each tooth with a fine instrument) and full-mouth dental radiography. Only X-rays show the roots, the bone around them, abscesses and retained roots. Anaesthesia-free cleaning cannot give these answers, and professional guidelines do not recommend it. Treatment — saving the tooth, root canal treatment or extraction — is usually done under the same anaesthetic, once agreed with you.

Sometimes it is only after treatment that owners realise how long their dog had been putting up with pain: it carries its toys again, plays more readily and is keen on treats.

How much an examination and treatment cost

You can start with an examination and consultation or an online consultation. The cost of treatment depends on how many teeth are affected and what the X-rays show, so I give the exact figure after diagnostics.

Frequently asked questions