[1] Sweet Tooth is designed around the premise of a killer clown that drives a combat ice cream truck, and his face has been featured on the cover of every Twisted Metal game, making him the series' mascot.
Starting with Twisted Metal: Black, his design became a large, somewhat overweight bare chested clown with a mask featuring a maniacal smile.
Sweet Tooth returns in Twisted Metal 2, seen for the first time with his familiar personality, which is reflected in his wish, which is to become a bug so he no longer has to live a life where he needs to kill people.
In Twisted Metal: Black (a reboot of the series), Sweet Tooth had a big make-over design-wise, giving him a more maniacal homicidal appearance.
In Twisted Metal: Lost, it is said in the bio of Yellow Jacket that his brother and Charlie were attempting to kill Needles, then themselves, to "end the bloodline of generations of murderers and psychopaths."
His passion for finding "the one that got away"—the only one of his would-be victims that managed to escape alive—is the driving force of his story and his motivation for entering the new Twisted Metal tournament.
After an unknown period of time, Marcus finally gave in to Needles' demands, externalizing the facet of himself by creating a macabre clown mask.
To celebrate his new freedom, the newly-named Sweet Tooth donned the clown mask (somehow setting his head ablaze in the process) and decided to murder "his" family.
He would later admit this was a mistake, as it gave the girl time to grab a pair of large scissors and drive them towards the mad clown's right eye (hitting just under).
After killing yet another woman on the hunt for Sophie, Sweet Tooth decides to enter Calypso's latest Twisted Metal contest, intent on using his wish to finally catch up with his elusive prey.
Calypso reveals that Sophie has been dead for ten years; her mind broken by the murder of her family, she committed suicide long before her father found the hospital she had lived in since that night.
Infuriated at Calypso's trickery, Sweet Tooth futilely attempts to escape his daughter's coffin while swearing to kill him, but he is far too deep in the ground to make any progress.
Having apparently heard of Sweet Tooth's passing, Charlie made good on his destiny by digging up Sophie's coffin, containing both her and her father, and retrieving the clown mask.
He spent the rest of his life in various mental institutions until the apocalypse, when he murdered his abusive mother and stepfather and lived alone in an abandoned Las Vegas resort until the events of the series.
[17] IGN called him one of the most notorious anti-heroes in gaming, saying "there's no real good guy in the Twisted Metal series" but that "Sweet Tooth ... stands out as a figurehead amongst this crew".
[19] He was included in GameSpot's "All Time Greatest Video Game Villain" contest and reached the "Sinister Sixteen" round before losing to Sarah Kerrigan.
[21] UGO Networks ranked him as the second "Best Twisted Metal Characters and Their End Game Videos", adding "[i]f there was a psychopathic clown college, the Joker would be the dean and Sweet Tooth would be its top professor".
The Safety Clown is a set of decals on their ice cream trucks and directs children to cross the street behind the van so that passing cars are more likely to see them.
Frosty Treats' CEO, Carl Long, stated in testimony that "they don't look the same way, but if the Safety Clown had a brother who was nasty and mean, it would look somewhat like Sweet Tooth".
In Frosty Treats, Inc. v. Sony Computer Entertainment America, Inc., the U.S. Court of Appeals for the Eighth Circuit ruled against the trademark claim because, even if Sweet Tooth was derivative, it was unlikely to cause confusion among consumers.