Hereditary gingival fibromatosis (HGF) is a rare, genetically transmitted disorder that only affects approximately 1 in 750,000 people. HGF is principally transmitted as on autosomal dominant trait. Autosomal recessive transmission has been reported infrequently in the literature. HGF primarily has its onset with the eruption of the permanent dentition, but it can also occur with the eruption of the primary dentition and can on rare occasions be present at birth. The gingival enlargement can be generalized or localized, and can vary in severity HGF can be on isolated entity or be part of a syndrome. The purpose of this case report was to describe the early onset of nonsyndromic hereditary gingival fibromatosis in a 28-month-old who had severe generalized gingival hyperplasia. Treatment consisted of surgically uncovering 16 primary teeth. Future surgical intervention will likely be required. (Pediatr Dent 2009;31:286-8) Received March 11, 2008 vertical bar Lost Revision July 1, 2008 vertical bar Revision Accepted July 28, 2008