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For some folks that don't use any death defiances on a run, the Lucky Tooth is worthless.
To be a bit facetious, I'd give a shout out to the Lambent Plume crowd - y'all know who the real hero is with the goodly boons. ;)
If I had to pick a single favorite, I'd probably go with either the Pom Blossom or Pierced Butterfly, but those are most useful if you select them first and keep them for the entire run. The individual gods' keepsakes are handy if I'm trying to go for a specific build, but I'll switch away from them at the soonest opportunity.
I think Lucky Tooth helps if you have a bad load out, but if you get a really good bit of luck, you want to capitilise on it by having a keepsake that boosts your play style best.
I'll equip it after Elysium if I have a bad run and feel like I'm going to choke on on the final boss, but that's about it.
But it ends up one of those cases where the player is good enough to survive without that item, and then they look for stuff that helps them clear enemies faster, and gain other advantages. As once they get used to dodging, and adjusting to enemy patterns. The priority is damage of any kind. If that makes sense. Not the best at explaining things.
I never used it.
Could have saved my run 3 or 4 times in 70+ runs/26 victories.
I used to take money+ for the extra 150$, then switch at the 2nd level.for the HP+50 one.
But have been experimenting with others latelly.
The plume is great with powerfull weapons like the fists/sword(when clearing rooms quickly is the norm)
The one that gives Random Boon level+1 every 4 room is nice too.
Perhaps you are beginner? As experienced player, I prefer to take specific God keepsake for first two acts (which will almost guarantee powerful set up for the end of game) and Evergreen Aconrn for Elysium and Styx (since bosses hits like a train, especially Hades - you will protect yourself way more with this keepsake).
I stopped playing with 101th winning streak and with all weapons heat 32-36. I used lucky Tooth only for learning game at the beginning, but later this keepsake is more like a dead weight to be honest.