Dental care is onDental-Care-for-Shih-Tzue of the most important aspects of your Shih Tzu’s health care program and should start while your Shih Tzu is still a puppy. Puppies are born without teeth. When Shih Tzu reach three to four weeks of age, their deciduous teeth start to erupt. At around 4 months, these 28 temporary teeth begin to fall out and are replaced with 48 permanent teeth.