Meth mouth, or crank decay, is commonly observed in methamphetamine users.40 The cause of meth mouth is multifactorial. Meth users commonly experience drug-induced cravings for high-calorie carbonated beverages.2,24 As a result, soft drinks containing high amounts of sugar and caffeine are often consumed to prolong the high and assuage the cravings.68 Reports indicate that Mountain Dew™ is commonly ingested by meth users; as much as several liters per day.68 The drug produces extreme xerostomia, reducing the amount of protective saliva and decreasing the pH thereby reducing the buffering capacity around the teeth.9,39,52 As a result of these behaviors, the oral bacterial levels can drastically increase, exacerbating the decay. The caustic nature of the drug, poor oral care and high sugar diet result in increased decay. This devastation can occur rapidly, in as little as one year. Conventional dental treatment is frequently of little value.8,21 Often, the caries are so significant and rampant that full-mouth extractions are indicated (Figure 7).