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My understanding is that Larry the Cable guy is a character-based stand-up comedy act, riffing off certain stereotypes of the Southern US hillbillies and rednecks. I'm guessing the point is that someone with "hillbilly teeth" for want of a better way of putting it - wide gaps between them, many teeth lost, could use that particular size!
@KILO NOVEMBER
Lost teeth would mean size 8. That would make sense.