<p>Permanent dental modifications are among the oldest and most continuously practiced body transformations in prehispanic Mesoamerica. Different contours were filed or cut into the anterior dental arches of youths and adults—sometimes children—along with dental inlays and tooth engravings. Used as single techniques or combined, these modifications once enhanced the looks of anterior front teeth among most of Mesoamerica’s ancient populations. Here, I lay out old and new methodological, factual, and interpretive foundations for their systematic (bio)archaeological study. I first focus on the foundational scholarship of Javier Romero in pan-regional coverage and the taxonomic systems to classify dental crafts. I then offer new conceptual framing on permanent tooth modifications from a life course approach together with a two-dimensional taxonomy of artificial dental contours, founded on ancient Mesoamerican body concepts and Native ideas of buccal functioning. I close with a survey of the relevant literature on permanent Mesoamerican dental modifications from the second millennium BCE up to today.</p>