Background Tuberculosis is a chronic granulomatous disease and an enormous health problem. Oral lesions are relatively uncommon, however, pulmonary tuberculosis may manifest with the involvement of the gingiva as the only primary finding.Case description The present case study reports tuberculosis of the gingiva manifesting as gingival enlargement. The diagnosis was based on sputum examination, histopathology and immunologic investigations. Anti-tubercular therapy was carried out with remarkable changes in gingival health within four months.Clinical implications and conclusion Gingival tuberculosis is a relatively uncommon occurrence and this case study emphasises the need for the clinician to include tuberculosis in the differential diagnosis of various types of gingival enlargement. Early detection and prompt treatment is the key for management of this highly infectious and communicable disease.