Shih Tzus are among the most dentally vulnerable dogs of any breed — and this isn’t an accident. Their anatomy combines two of the worst possible dental risk factors: the crowded teeth of a small breed and the compressed jaw of a brachycephalic (flat-faced) breed. The result is a dog that will almost certainly develop serious dental disease without active, consistent preventive care.
If you own a Shih Tzu, understanding exactly why their teeth are so vulnerable — and what the specific care protocol looks like — is the foundation of keeping them healthy throughout their typically long (10–18 year) lives.
Why Shih Tzus Have Especially Bad Dental Health
Most dogs have 42 adult teeth in a jaw built to hold them reasonably well. Shih Tzus have 42 adult teeth compressed into two overlapping disadvantages:
Small Breed Crowding
Like Chihuahuas, Yorkies, and Dachshunds, Shih Tzus are toy-sized dogs with a full 42-tooth count in a very small jaw. The teeth don’t fit properly — they overlap, rotate, and grow at angles that create constant food and bacteria traps between adjacent teeth. This drives rapid tartar accumulation and early periodontal disease.
Brachycephalic Compression
Shih Tzus are a brachycephalic breed — their skull is shortened front-to-back, pushing the jaw structure forward and compressing the dental arcade even more than their small size alone would cause. The nose is essentially pushed back toward the skull, while the lower jaw is often relatively normal length, creating a characteristic slight underbite. The teeth of both jaws are dramatically compressed, and in many individual Shih Tzus the upper and lower teeth contact each other abnormally because of the mismatched jaw length.
The Combined Effect
A Shih Tzu’s teeth are packed into a jaw that’s small vertically (small breed), compressed horizontally (brachycephalic), and often experiencing abnormal contact patterns between upper and lower dentition. This is the worst-case scenario for dental health: no tooth surface is correctly positioned, cleaning anything properly is nearly impossible, and tartar accumulates in every protected angle and pocket.
Shih Tzu owners routinely discover their dog needs multiple extractions at their first professional dental cleaning — even at relatively young ages (2–4 years) if home care hasn’t been consistent.
Common Dental Problems in Shih Tzus
Severe, Early-Onset Periodontal Disease
Periodontal disease is the dominant dental condition in Shih Tzus, and it progresses faster than in almost any other breed. The combination of crowding and brachycephalic compression creates pockets and ledges where bacteria accumulate constantly. By age 2–3, many Shih Tzus without active dental care have significant tartar buildup and early-to-moderate periodontal disease. By age 5–6 without treatment, tooth loss is common. Learn the disease stages: Periodontal Disease in Dogs — Stages and Treatment.
Retained Baby Teeth
Retained deciduous teeth are very common in Shih Tzus, as in all small toy breeds. When adult teeth erupt alongside retained baby teeth, the double-tooth spaces create concentrated areas of disease. These should be extracted at spay/neuter or at a dedicated dental procedure under anesthesia.
Abnormal Bite and Tooth Contact
The Shih Tzu’s brachycephalic skull frequently results in varying degrees of underbite (lower jaw extending slightly beyond upper), and sometimes more complex misalignment. When teeth contact each other abnormally, some teeth wear faster, gum tissue can be traumatized by abnormal contact points, and the overall dental arcade behaves differently than a normally aligned mouth. Severe malocclusion causing pain or tissue injury requires veterinary dental consultation.
Narrow Palate and Hard-to-Clean Surfaces
Shih Tzus have a narrow, high-arched palate. The inner surfaces of their teeth (facing the tongue and palate) are nearly impossible to reach with standard brushing. This means that despite diligent home care, some tooth surfaces remain effectively uncleanable at home — underscoring why professional scaling remains essential even with regular brushing.
Shih Tzu Dental Care Routine
Daily Brushing — Non-Negotiable
For Shih Tzus, daily brushing is the minimum that provides meaningful protection — not an aspirational goal, but the actual clinical recommendation from veterinary dentists for this breed. The combination of crowded, brachycephalic-compressed teeth means the disease window between plaque formation and tartar mineralization is effectively shorter for Shih Tzus than for most breeds.
The challenge: Shih Tzus often have a flat face, narrow snout, and a temperament that can make oral handling difficult. Many owners find that a small finger brush works better than a full toothbrush for this reason — it allows better navigation in a very small, compressed mouth. Start small (literally a 10-second touch), reward heavily, and build consistency over weeks rather than trying to achieve a full brushing session immediately.
Use enzymatic dog toothpaste. The enzymatic action works even on the surfaces you can’t physically brush — it produces hydrogen peroxide in the saliva that circulates through the mouth. Never use human toothpaste; xylitol is highly toxic to dogs.
→ Full technique: How to Brush Your Dog’s Teeth the Right Way
Soft Dental Chews for Toy Breeds
Dental chews provide mechanical cleaning, but Shih Tzus need soft-to-medium density chews rather than hard ones. Their teeth are smaller and the brachycephalic jaw means their bite applies force differently. Hard chews risk both tooth fractures (less common than in strong-jawed breeds but possible) and frustration if the dog can’t actually chew through the product.
VOHC-approved dental chews in toy breed sizing provide the best evidence-based benefit. Look for products that require 5–10 minutes of active chewing from a small dog — if it disappears in 30 seconds, it provided minimal cleaning benefit. See our recommendations: Best Dental Chews for Dogs.
Dental Water Additives
Adding a VOHC-approved dental water additive to your Shih Tzu’s water bowl is particularly valuable for this breed. Because some of their tooth surfaces cannot be properly cleaned by brushing alone, a daily passive antibacterial layer from their water provides meaningful additional protection. Use every day, change the water bowl daily.
Enzymatic Dental Sprays or Gels
For the inner tooth surfaces that brushing can’t reach in a Shih Tzu mouth, enzymatic dental sprays or gels applied to the accessible surfaces can help circulate active enzymes throughout the mouth. These aren’t as effective as direct mechanical cleaning but provide supplemental benefit in an anatomically challenging mouth.
Professional Dental Cleanings for Shih Tzus
Shih Tzus require professional dental cleaning every 6 months — and some individual dogs with particularly severe crowding may benefit from every 4 months. This is more frequent than most breeds, but it reflects the reality of how quickly tartar accumulates and how much bone loss can occur in a 6-month window in this breed.
Important Shih Tzu anesthesia note: Shih Tzus are brachycephalic, which means anesthesia carries more risk for them than for non-brachycephalic breeds. Their narrowed airways, elongated soft palates, and stenotic nares (small nostrils) can complicate anesthetic management. Choose a vet experienced with brachycephalic breeds for dental procedures — they’ll use appropriate anesthetic protocols and monitoring, and be prepared to manage the airway throughout the procedure.
The risk of properly managed anesthesia in a healthy Shih Tzu is substantially lower than the risk of untreated periodontal disease. But “experienced with brachycephalic breeds” is genuinely important in this context — don’t let a vet minimize this difference.
Dental X-rays at every cleaning are essential for Shih Tzus — the compressed anatomy makes it impossible to assess root health by visual exam alone, and Shih Tzus regularly have roots in abnormal positions that require imaging to evaluate.
→ What to expect: What to Expect After Dog Dental Cleaning
Shih Tzu Facial Skin Fold Hygiene and Dental Health
Shih Tzus with deep facial skin folds around the muzzle can accumulate moisture, food particles, and bacteria in the folds adjacent to the mouth. While this is primarily a skin issue, severe fold accumulation near the oral commissure (corner of the mouth) can contribute to perioral inflammation that affects adjacent gum tissue. Keeping facial folds clean and dry is good grooming hygiene that also indirectly supports oral health.
Signs of Dental Problems in Shih Tzus
Watch monthly for:
- Yellow-brown tartar crust at the gumline — very common even at 2–3 years without brushing
- Red, swollen, or receding gum tissue
- Persistent bad breath
- Eating slowly, preferring soft food, or dropping kibble
- Face rubbing on the carpet (can indicate oral discomfort)
- Pawing at the face or mouth
- Visible loose teeth (should never be present in healthy adult dogs)
- Facial swelling (tooth abscess)
- Retained baby tooth after 7 months (two teeth in one spot)
→ Warning signs: Signs Your Dog Needs a Professional Teeth Cleaning
Frequently Asked Questions About Shih Tzu Teeth
How many teeth do Shih Tzus have?
Adult Shih Tzus have 42 teeth — the same as all dog breeds. Shih Tzu puppies have 28 baby teeth that are replaced by adult teeth between 3–7 months. The combination of 42 adult teeth in both a small body and a brachycephalic skull is the source of their severe dental crowding.
How often should a Shih Tzu get their teeth cleaned by a vet?
Every 6 months is the recommended standard for Shih Tzus. Some individuals with particularly compressed dentition may benefit from every 4 months. Annual cleanings leave too long a window for the tartar accumulation and bone loss that occur rapidly in this breed.
Why does my Shih Tzu have such bad teeth?
Shih Tzus combine two independent dental risk factors: small-breed crowding (42 adult teeth in a small jaw) and brachycephalic compression (a shortened skull that further compresses the dental arcade). This double disadvantage makes dental disease nearly inevitable without intensive preventive care.
My Shih Tzu had 10 teeth extracted — is that normal?
Unfortunately, yes — multiple extractions are very common in Shih Tzus, especially those whose dental care was delayed. Shih Tzus adapt well without many teeth and typically eat and act normally after recovery. Many owners report dramatically improved energy and comfort after extensive extractions, as the chronic pain that dogs mask so well is finally resolved.
Can I use coconut oil on my Shih Tzu’s teeth?
Yes — coconut oil is safe for Shih Tzus and provides antibacterial benefits (lauric acid reduces plaque-forming bacteria). It’s particularly useful as a training bridge for dogs that resist toothpaste. See: Coconut Oil for Dog Teeth: Does It Really Work?
The Bottom Line
Shih Tzus are beautiful, long-lived dogs whose dental health requires more active management than almost any other breed. The combination of small-breed crowding and brachycephalic compression creates dental disease conditions that will cause serious damage without intervention — but which respond well to consistent daily care.
Start dental handling from puppyhood if possible. Build the daily brushing habit early. Schedule professional cleanings every 6 months. Choose a vet experienced with brachycephalic anesthetic management. And check the mouth monthly. These four habits will keep your Shih Tzu’s mouth — and their quality of life — in the best possible condition for their exceptionally long lifespan.
Related reading: French Bulldog vs Shih Tzu dental problems
Related reading: Lhasa Apso teeth vs Shih Tzu dental comparison