Tough Love is a passive item.
- Adds a chance to shoot a tooth instead of a tear, which deals greater damage (x3.2) than regular tears.
- The chance to fire a tooth depends on the luck stat. The activation rate is equal to 1/(10 - Luck). At base luck (0), the chance is 10%, maxing out at 100% at 9 luck.
- Apple!: With 14 luck, overrides Tough Love, though the razor blades do more damage anyways. With 13 luck, Apple and Tough Love each have about an equal chance to trigger.
- Brimstone: Overridden by Brimstone.
- Occasionally fires Brimstone beam with damage multiplier of Tough Love.
- Cricket's Body/ Compound Fracture: Teeth will split into smaller teeth.
- Dr. Fetus: Bombs explode with the increased blast damage and radius of Mr. Mega.
- Adds a chance for the bombs to deal increased damage. See the page for the specific damage formula.
- Fire Mind: Adds flaming effect to the teeth, but without the chance of exploding.
- Tears will still explode.
- Ipecac: Teeth explode with the increased blast damage of Mr. Mega.
- Mom's Knife: Overridden by Mom's Knife.
- : Both damage multipliers apply, combined damage multiplier is x6.4.
- Haemolacria: Tears will not appear as teeth but may still gain the damage multiplier.
- Jawbreaker: Activation rates are individually applied to each tear, effectively allowing for higher amounts of teeth. However at 9 Luck, the trinket is no longer needed, as Tough Love will already guarantee that every shot is a tooth at that point.
- The Parasite: Split tears will not turn into teeth.
- Spirit Sword: Both the sword and projectiles can deal increased damage.
PC Z0ZB KE22 (First floor Treasure Room)
PS4 WQVF HG7V (First floor Treasure Room)
Vita ZNHL AJ8K (First floor Treasure Room)
3DS SGKP 3D9S (Treasure Room adjacent to spawn)
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