Evidence of cultural dental modification in a precontact (pre-1521) skeletal sample from the Academy of Our Lady of Guam gymnasium site in Agana, Guam, is documented. Two of the four individuals recovered at the Academy Gym site exhibit modification of the maxillary teeth. One individual displays vertical incising of a single tooth, and the other exhibits horizontal abrading of the anterior teeth which may be a purposeful or an incidental alteration. Although deliberate alteration of the dentition, including tooth extraction, notching, filing, and drilling, has been documented in human groups worldwide, little has been written about these cultural practices in the Mariana Islands. Examination of the available literature on precontact human remains from the region reveals at least three patterns of dental incising and similar cases of dental abrasion. While the origins of these practices are not known, the presence and style of these cultural alterations may be sex-specific, cosmetic in nature, or an indication of status in a ranked society. Alternatively, they may signify membership in a particular group or lineage, or mark a rite of passage. Because the comparative samples are limited in number and small, and the provenience of many of the skeletons is obscure, temporal variation cannot be ruled out.