Loose or lost tooth in a dog or cat: what to do

Important note for owners

Found a tooth at home? Keep it until the consultation and, if you can, photograph the spot where it came out. You can't always tell from the tooth itself whether it came out whole — part of the root may stay in the socket, so a photo doesn't replace an examination. Permanent tooth already in, but the temporary one next to it hasn't fallen out? See “Retained temporary teeth”.

Most common possible causes

• —Periodontitis with bone loss. The most common cause of loose teeth in adult dogs and cats. Plaque and tartar keep inflammation going under the gums, and the ligament and bone around the root are gradually destroyed. The less bone is left, the looser the tooth. In small dog breeds this usually starts earlier.
• —Trauma: a displaced or knocked-out tooth. After a blow, a fall, a fight or play with hard objects, a tooth can shift in its socket (luxation) or fall out. Such a tooth should be seen as soon as possible.
• —Root fracture. The crown can look intact while the tooth moves because the root is broken inside the bone — this is visible only on a dental radiograph. It can also be the other way round: the crown breaks off and part of the root stays in the bone.
• —Puppies and kittens changing teeth. From roughly 3 to 7 months of age, temporary (baby) teeth loosen and fall out to make way for permanent ones — this is normal. It is a concern when a temporary tooth stays put although the permanent tooth next to it has already come through.
• —Tooth resorption (TR). Especially common in cats: the tooth tissue is gradually destroyed, and the crown may loosen or break off. The roots can be assessed only on dental radiographs.
• —Tumours and other bone lesions. Sometimes teeth shift or loosen because of a growth in the gum or jaw or another bone disease. If changes look suspicious, a biopsy is taken.

When not to postpone an exam

• ✓A permanent tooth is loose — even slightly
• ✓A tooth has fallen out in an adult pet
• ✓There is bad breath, plaque or tartar
• ✓The gums are red, bleed or have receded and exposed the root
• ✓Your pet avoids hard food or toys, or eats on one side
• ✓There is pain when the muzzle is touched
• ✓Tissue, blood or a possible fragment is visible in the socket
• ✓It is unclear whether the tooth was a temporary one

Urgent help needed

• ✓A tooth has been displaced or knocked out after an injury
• ✓Active bleeding that will not stop
• ✓An injury to the face or jaw, and your pet cannot open or close its mouth normally
• ✓Rapidly increasing swelling of the face, cheek or under the eye
• ✓Difficulty breathing
• ✓A sudden deterioration in general condition or loss of consciousness after an injury

What you can do at home

• ✓Until the examination, switch to soft or soaked food to take the load off the tooth.
• ✓Put away bones, antlers, hard treats and tough toys; pause tug-of-war games.
• ✓Don't brush the area with the loose tooth before the examination; the other teeth can be brushed if your pet calmly allows it.
• ✓If the tooth fell out on its own because of gum disease, put it in a container and bring it to the appointment; photograph the socket. If it was knocked out in an injury, keep it moist (in saline or cold milk) and go to the vet at once.
• ✓Note when you noticed the looseness, whether there was an injury and whether your pet eats differently.
• ✓Not sure how urgent it is? Send photos for an online consultation on Telegram.

What not to do at home

• —Don't wiggle or pull the tooth yourself: the root can break and stay in the bone, and your pet may bite out of pain
• —Don't try to remove possible root fragments
• —Don't treat the socket with alcohol, peroxide or other harsh agents
• —Don't give human painkillers: ibuprofen and paracetamol are dangerous for dogs and especially for cats
• —Don't delay an examination just because your pet keeps eating
• —Don't allow chewing on hard bones, antlers or rigid toys before the examination
• —Don't expect gels, vitamins or calcium to “strengthen” the tooth — they don't restore lost bone around the root

What diagnostics may be needed

• ✓Consultation: which teeth are loose, the state of the gums, bite, plaque and tartar
• ✓Examination of every tooth under anaesthesia as part of COHAT
• ✓Periodontal probing: pocket depth and the degree of mobility of each tooth
• ✓Full-mouth dental radiography: how much bone is left, whether the root is intact, whether a fragment remains
• ✓After an injury — assessment of the jaw, bite and neighbouring teeth
• ✓If a tumour is suspected — a biopsy

You can see at home that a tooth is loose, but not why. Mobility from bone loss, a root fracture or a luxation after an injury looks similar from the outside, yet the treatment differs. How much bone is left around the roots and whether the root is intact is shown only by dental radiography, and pocket depth is measured by probing under anaesthesia. Even if the crown is already gone, part of the root may remain in the bone.

How treatment may proceed

• ✓A temporary tooth that is loose at the expected age — observation; if the permanent tooth is already in and the temporary one won't fall out — extraction of the temporary tooth
• ✓A tooth with slight mobility and enough bone support can sometimes be kept: professional cleaning as part of COHAT and periodontal treatment when clinically indicated
• ✓A tooth that has lost much of its bone support is usually extracted — under anaesthesia, with local nerve blocks and after radiographs
• ✓After an injury — repositioning and stabilising the displaced tooth, or extraction, depending on the root and bone
• ✓Removal of root remnants when clinically indicated
• ✓Home care and follow-up checks to protect the remaining teeth

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