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The incidence of tuberculosis is increasing worldwide. The disease has a variable mode of presentation and therefore diagnosis is not easy. Although a rare occurrence, the differential diagnosis of tuberculous osteomyelitis must always lurk in the deepest recesses of the dental clinician's mind when routine therapy fails to bring about an improvement in lesions of the jaw. We present an unusual case of tuberculous osteomyelitis in a 4-year-old boy in whom pulmonary tuberculosis was detected only subsequently and emphasize the role of history taking, diagnostic techniques, and management.