Inscryption (UP)

This achievement is cumulative, so it will count all teeth pulled with a pliers throughout every run in Kaycee's mod. There are a couple of tips you can follow to speed up unlocking this achievement that are relatively straight-forward, but I'll just list them out anyways:

1. You'll always start with a pliers on each new run - theoretically you could just start and restart fresh runs after pulling a tooth in your first battle 32 times to unlock this, but what's the fun in that? You may as well try to make progress on the challenges.
2. Do not choose the 2-slot backpack challenge, there will be fewer chances to get a pliers.
3. Visit the backpack icons as you progress through the map. These events allow you to fill all your item slots. You can try to use up all your items in a battle prior to visiting the backpack station so you get the maximum amount of items. OR, you can keep a full backpack and get a Pack Rat card, which gives you a free item when played in a battle. Either way, always try to visit a backpack item with either completely full or completely empty items slots. If you're further along in your run, getting the Pack Rat card is probably less desirable since there is less of a chance to draw it from a relatively larger deck.
4. Use your pliers! It is obvious, but use your items before the end of your run, otherwise you would have wasted a chance to use them - items do not carry over between runs. There were a few times when my run was going so well, that I simply didn't need to use items to win, and I overlooked the chance to use them.

Fun fact: your typical adult human has 32 teeth, so after getting this achievement you're going to need some dentures.