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The initial concept of the album was an exploration of "loss and possible discovery of self, along with alternate layers of reality and perception set inside a nightmare you can't seem to wake up from; with lots of feedback." Around this time mysterious quotes and binary codes appeared on nin.com, including a passage from the book ''[[wp:The Lathe of Heaven|The Lathe of Heaven]]'' by Ursula K. Le Guin, containing the phrase "bleed-through". The working title for ''With Teeth'' was ''Bleedthrough'', referencing the phenomenon of audio bleed-through.
Pre-production and initial recording began in 2003, and the original album title was announced by ''Alternative Press'' in November.[https://www.theninhotline.com/news/permalink/1069729309]. The concept lasted far enough into the recording process that Rob Sheridan had mocked up an album cover with the original title. In an [http://www.rollingstone.com/news/story/5937146/nine_inch_nails_let_it_bleed/ interview] in February 2004, Reznor stated that the new material was "more song-oriented (than ''[[The Fragile (halo)|The Fragile]]''). It's much more lean. It's going to be twelve good punches in the face -- no fillers, no instrumentals, just straight to the point…It's a complicated concept record, but reduced to just simple songs. It's not epic in its scope. It's minimal and a bit brutal."
In response to a [[Access#2004_10_18|question posted]] on October 18, 2004 to the Access section of nin.com, Reznor announced that the working title ''Bleedthrough'' had been dropped. Reznor stated that the name was changed because "it was supposed to be about different layers of reality seeping into the next, but I think some people were thinking about blood or a tampon commercial." "'Bleedthrough' is no more," Reznor wrote in a message posted on nin.com, "as the songs and concepts matured, the focus and theme of the album shifted somewhat--leaving me feeling that title was inappropriate. Or you could just say I changed my mind. Yes, the new album has a title and track list, and no I'm not telling you what it is yet."