Dentistry is arguably the veterinary specialty most greatly impacted by the effects of selective and deliberate breeding of dogs for desired traits. This selective breeding creates unique anatomic features of the mandible and mandibular teeth that can drastically complicate dental treatment. Magnified by the mismatch between body size, jaw height, and tooth size, the mandibular first molar tooth’s large size creates various challenges with exodontics, endodontics and mandibular fracture repair. As long as dogs have mandibular first molars, veterinary dentists will have job security. This presentation will review the contemporary literature focused on everything associated with the mandibular first molar tooth. The mandibular first molar tooth is a common fracture location in dogs. Decreased mandibular bone height, periodontal ligament surrounding the roots, thinning of buccal cortical bone, and increased root volume in small breed dogs all result in the development of a stress riser at this location. Clinical decision-making on whether to maintain the tooth in the fracture line, the importance of the tooth in non-invasive jaw fracture stabilization, and evaluation of different forms of fixation at this location have all been reported. In addition to being a location for fracture repair, these teeth are commonly periodontally compromised in small breed dogs and require extraction. The anatomic location of the root apices relative to the mandibular canal can complicate the approach for apicoectomy and inadvertently damage the neurovascular bundle due to careless instrument use.