The oral signs and symptoms of methamphetamine abuse are significant and severe. The dental professional is often the first to observe the signs of meth abuse, the most dramatic sign of which been termed “meth mouth.”1 Figures 6A and 6B show the damage caused by meth as well as a post-treatment photo. This is a distinctive pattern of caries on the facial and proximal surfaces of teeth, especially the anterior teeth. It is an aggressive erosion of enamel accompanied by destruction of periodontal tissues. Teeth have been described as blackened, stained, rotting, crumbling or falling apart. The rampant caries resemble radiation caries, early childhood caries or “pop rot” but lacks the associated etiology. Through elimination of other causative agents, a differential diagnosis of meth mouth can be made.