Background <p>Leukemia is correlated with alveolar bone loss, while remission is reportedly associated with an increase in alveolar bone volume. However, there have been no reports from Japan detailing substantial recovery of the alveolar bone following remission from leukemia.</p> Case presentation <p>A 14-year-old male patient presented to our clinic with fatigue, a low-grade fever, and bilateral mandibular molar tooth movement with gingival swelling around the molars that affected his ability to eat. Panoramic radiography revealed alveolar bone resorption in both jaws, while the alveolar hard line, mandibular canal wall, and trabecular structure were indistinct. The patient had an elevated white blood cell count and blasts were observed in the peripheral blood. Additionally, C-reactive protein, lactate dehydrogenase, and ferritin levels were elevated. These findings suggested leukemia. Bone marrow biopsy confirmed acute lymphocytic leukemia (ALL). ALL invasion had caused alveolar bone resorption and loose teeth, resulting in difficulty eating. He was started on IA4 remission induction therapy and consolidation therapy. The patient experienced successful remission.</p> Conclusions <p>After chemotherapy, the patient recovered oral function, which allowed him to resume normal food intake. Notably, the alveolar bone recovered considerably and tooth movement disappeared. Clinicians should consider alveolar bone resorption and tooth mobility as potential early signs of ALL in pediatric patients and recognize that timely chemotherapy can offer substantial oral recovery and alveolar bone regeneration.</p>