Teeth growing crooked or not meeting in dogs and cats

Important note for owners

This page is about teeth that grow crooked or meet incorrectly and become that way gradually, while the teeth are changing or the jaws are growing. Two similar situations have their own pages (links are in the “Similar symptoms” section below). If it is specifically a lower canine pressing into the palate, read “Lower canine hitting the palate”: it has its own treatment approach. If the mouth has suddenly stopped closing or opening, the jaw hangs open, or after an injury the teeth meet completely differently, this is a jaw or joint problem rather than a bite problem, and urgent help is needed — see “Cannot close or open the mouth”.

Most common possible causes

• —Genetics and jaw shape. The length and width of the jaws are largely determined by genetics. In short-nosed breeds — French Bulldogs, Pugs, Shih Tzus, Persians — the lower jaw often protrudes; in other animals it is shorter than the upper jaw, and sometimes the two halves of the jaw grow unevenly, making the face asymmetrical.
• —Retained deciduous teeth. If a deciduous tooth stays in place while the permanent one is already erupting next to it, it pushes the permanent tooth off its path: lower canines inwards towards the palate, upper canines forwards, and the incisors become crowded. This cause can be dealt with in time.
• —Crowded teeth in small and short-nosed breeds. In a short jaw the teeth run out of room: premolars rotate, sit at an angle or end up tightly packed together. Food and plaque get trapped between such teeth, so periodontal disease develops faster.
• —Injury during growth. A blow or jaw fracture in a puppy or kitten can damage developing tooth buds or the growth areas of the bone. The teeth may then erupt out of place and the jaws may grow asymmetrically.
• —A jaw fracture that healed out of alignment. If a fracture healed with displacement, the teeth no longer meet the way they used to: they may injure the gums, palate or other teeth, and sometimes stop the mouth from closing fully.
• —Changes in adulthood. Periodontal disease destroys the bone around the roots, and the teeth gradually shift. In cats an upper canine sometimes seems to “grow longer” as it moves out of its socket — this is linked to inflammation of the bone around the root and to tooth resorption (TR). A growth in the mouth can also push teeth aside, so a “new” crooked tooth in an adult animal is a reason for an examination.

What owners notice

A bad bite (vets call it malocclusion) is easier to spot if you lift the lips while the mouth is closed and look at the teeth from the front and from both sides. This is what owners usually notice:

• ✓The front teeth don't meet in a “scissor” bite: the lower incisors sit in front of the upper ones, or there is a gap between them
• ✓The lower jaw sticks out or, on the contrary, is noticeably shorter than the upper jaw
• ✓A lower canine presses into the palate or the gum just inside the upper canine
• ✓The teeth are crowded, rotated or overlapping
• ✓The jaw is shifted to one side and the face looks asymmetrical
• ✓Two teeth of the same type stand side by side: a deciduous tooth hasn't fallen out and is pushing the permanent one

When a bite is just a trait and when it hurts

A bite that is typical for the breed is not a disease in itself, and I assess your pet's comfort rather than the breed standard. If a Pug's or Persian's lower jaw protrudes but the teeth don't injure the gums and lips, and your pet bites into food and chews toys without trouble, monitoring and daily dental care are usually enough.

It is a different matter when abnormal tooth contact injures tissue. Animals with chronic mouth pain don't often show it clearly: they keep eating, just more carefully. So I look for objective signs:

• ✓a tooth presses into the palate, gum or lip and leaves sores, pits or imprints
• ✓teeth knock against each other — they wear down, chip, crack or change colour
• ✓food and plaque collect between crowded teeth, the gums are inflamed and there is a smell
• ✓your pet bites carefully, drops food, is reluctant to chew toys or paws at the face
• ✓sneezing or nasal discharge — a sore in the palate may have opened into the nasal cavity

Puppies and kittens versus adult animals: what matters at each age

In puppies and kittens timing matters. Deciduous teeth erupt in the first weeks of life, and permanent teeth from about 4 to 7 months (average timings from the Merck Veterinary Manual; they are similar in kittens). This is when the bite changes most, and when the simplest solutions are available.

If the deciduous lower canines are already hitting the palate (at 2–4 months), extracting them early can release the “lock” between the jaws and give the lower jaw a chance to reach its genetically determined length, but no more. If a deciduous tooth is standing next to a permanent tooth that has already erupted, don't wait until 7 months: two teeth of the same type in one place are a reason for an examination now.

In an adult animal the bite is already established and will not change on its own. Here I check whether the teeth injure the gums and palate, and look for wear, chips and periodontal disease where teeth are crowded. And if the bite has changed from what it used to be, an examination is needed to find the cause — anything from an old injury to a growth in the mouth.

When not to postpone an exam

• ✓A tooth touches the palate, gums or lip: sores, pits, tooth imprints, bleeding
• ✓A deciduous and a permanent tooth of the same type are standing side by side
• ✓Your puppy or kitten bites into food carefully, drops it or refuses anything hard
• ✓In an adult animal, the teeth have started to meet differently than before
• ✓Teeth are wearing down, chipping or changing colour where they make abnormal contact
• ✓Bad breath, plaque and inflamed gums between crowded teeth
• ✓Sneezing or nasal discharge together with a sore in the palate

Urgent help needed

• ✓After an injury the mouth has suddenly stopped closing or the teeth meet completely differently
• ✓Your pet cannot open its mouth or swallow, and is drooling heavily
• ✓Bleeding from the mouth that will not stop
• ✓Difficulty breathing
• ✓Rapidly increasing swelling of the face or under the eye

What you can do at home

• ✓Lift the lips and photograph the bite from the front and from both sides with the mouth closed. In puppies and kittens, repeat the photos every few weeks — this makes changes easier to spot.
• ✓Look at the palate just inside the upper canines and at the gums next to the lower ones: sores, pits or tooth imprints are a reason to book an examination.
• ✓Note when the deciduous teeth fell out, and watch for two teeth of the same type standing side by side.
• ✓Brush the teeth daily, especially if they are crowded: plaque builds up faster between them.
• ✓Offer soft rubber toys instead of hard chews.
• ✓Send the photos for an online consultation on Telegram — I'll tell you how urgent an examination is, but photos don't replace an in-person bite assessment.

What not to do at home

• —Don't file teeth down yourself: there is living pulp under the crown, and damaging it can lead to infection and death of the tooth
• —Don't pull out deciduous teeth at home — the root can break and stay in the bone, and the developing permanent tooth can be damaged
• —Don't give hard bones, antlers or tough chews: with abnormal contact, teeth break and wear down faster
• —Don't start “exercises” with a ball or toy without a vet's advice: the wrong size can harm the bite
• —Don't wait for your pet to “grow out of it” if a tooth is already injuring tissue: the window for simpler interventions closes
• —Don't give human painkillers — many of them are toxic to dogs and cats

What diagnostics may be needed

• ✓Consultation: assessment of the bite from the front and both sides, of jaw length and symmetry, and of contacts between the teeth
• ✓Examination of the palate, gums and lips: whether there are sores, how deep they are, and whether there is a communication with the nose
• ✓Dental radiography under inhalational anaesthesia, given and monitored by a separate veterinary anaesthetist: roots of deciduous teeth, unerupted teeth, how far the roots have developed and how wide the pulp is
• ✓Examination of every tooth as part of COHAT if there is crowding, worn or fractured teeth or periodontal disease
• ✓If needed, impressions and models of the jaws to plan an orthodontic appliance; if a joint problem or a badly healed fracture is suspected, CT may be needed

A photo shows the position of the crowns, but not the roots of deciduous teeth, unerupted teeth or how far the permanent teeth have developed. This determines whether a tooth can be moved, shortened or is better extracted, so I make a treatment plan only after an examination and dental X-rays.

How treatment may proceed

• ✓Treatment is chosen when clinically indicated, after an examination and X-rays; if the teeth don't injure anything, monitoring and daily dental care
• ✓Extraction of deciduous teeth that haven't fallen out or are “locking” the jaws — under anaesthesia, after an X-ray, carefully so as not to damage the developing permanent tooth
• ✓Orthodontic correction — for example, an inclined plane that gradually guides a tooth into the right position; in mild cases, exercises with a ball of the right size under my supervision. Rechecks and daily care of the appliance are needed
• ✓Crown reduction with vital pulp therapy: the tooth stays alive, the pulp is protected and sealed with a filling, and the result is monitored on X-rays
• ✓Extraction of the offending tooth, or of crowded teeth that keep periodontal disease going, when other methods are not suitable
• ✓Treating the consequences: sores in the palate heal once the contact is removed; worn or fractured teeth are treated, and a communication with the nose is closed surgically
• ✓The outcome depends on age, genetics and how closely the plan can be followed; I calculate the cost after diagnostics — it depends on the method and the extent of treatment

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