Rampant caries is one of the hallmarks of chronic methamphetamine abuse. "Meth" is a potent central nervous system stimulant with physical and psychological effects similar to cocaine. It is the author's opinion that the caries associated with methamphetamine abuse is related to three risk factors: 1) xerostomia caused by the drug; 2) a subsequent increase in sugared soft drink consumption; and 3) lack of oral hygiene during extended periods of abuse. Patients in this risk group usually present for treatment due to severe pain. However, they may be reluctant to discuss their illegal drug habit. Anorexia may also be present. Treatment includes cessation of drug abuse, oral hygiene, restrictions on sugar intake, and daily fluoride supplementation. Such patients tend to exhibit poor compliance with treatment recommendations or fail to show for appointments.