Methamphetamine is a potent central nervous system stimulant that can cause shortness of breath, hyperthermia, nausea, vomiting, diarrhea, irregular heart beat, high blood pressure, permanent brain damage, and rampant tooth decay. Some users describe their teeth as “blackened”, stained, rotting, crumbling, or falling apart. Often the teeth cannot be salvaged and must be extracted. The extensive tooth decay is attributed to the drug’s acidic nature and its tendency to dry mouth tissues. A methamphetamine “high” lasts much longer that produced by crack cocaine (12 hours versus one hour for cocaine). This can lead to long periods of poor oral hygiene, and while a user is high they often crave high-calorie, carbonated, sugary beverage or they may grind or clench their teeth, all of which can harm teeth. Heavy users may appear malnourished because methamphetamine acts as an appetite suppressant. Decay that is caused by methamphetamine is very distinctive. The decay will appear on the buccal surfaces (cheek side surface) of posterior teeth and in-between the front teeth.