Evaluation of a 13-Month-Old Anemic Child With Gushing Gums

While it is common practice for adults to brush their teeth twice a day and instill in their children the importance of setting hygiene routines centered around brushing their teeth, infants and toddlers are often overlooked. Infants begin teething around four to seven months of age; during this period of tooth eruption, their gums are highly susceptible to bacterial build-up, causing problems long before oral hygiene comes to mind. We describe a case of a 13-month-old child presenting with bleeding gums and worsening anemia. After blood tests, iron supplementation, and a referral to a pediatric hematologist-oncologist out of concern for a potential bleeding disorder, this patient was diagnosed with normochromic, normocytic anemia caused by bleeding due to infectious gingivitis. After the completion of antibiotic therapy and changes to the patient's routine to incorporate appropriate oral hygiene, the anemia resolved. Generally benign, gingivitis induced by plaque biofilm can advance to more severe forms of periodontal disease, leading to receding gums and abscesses, thus reinforcing the importance of promoting adequate oral hygiene in all ages regardless of dentition. Additionally, educating primary-care providers on pediatric gingivitis allows for the inclusion of this diagnosis on differentials, limiting extensive blood tests and specialist appointments.