Epstein Pearls are common, harmless, noncancerous cysts frequently present in a newborn’s mouth shortly after birth. Affecting up to 85% of infants, they are benign oral findings. Despite their appearance, which can resemble tiny emerging teeth, Epstein Pearls require no medical intervention. Understanding their nature provides reassurance during the first weeks of a baby’s life.
Description and Location
Epstein Pearls present as small, firm nodules, typically pearly white or yellowish, measuring 1 to 3 millimeters in diameter. They appear as single lesions or small clusters beneath the mucous membrane.
Their location differentiates them from other similar cysts. Epstein Pearls are found along the midline of the hard palate, the bony front section of the roof of the mouth. This precise location is a hallmark of the condition.
Other Oral Cysts
Other benign oral bumps, such as Bohn’s nodules and dental lamina cysts, look similar but are found elsewhere. Bohn’s nodules are generally found on the gums and are remnants of small salivary glands. Dental lamina cysts also occur on the gums, developing from fragments of tissue involved in tooth formation.
Embryological Origin
Epstein Pearls form during fetal development when epithelial tissue becomes trapped during the fusion of the palatal shelves. The palate develops from two separate shelves that grow toward the middle and join together.
When these shelves merge, fragments of the surface epithelium can become enclosed. These trapped cells accumulate keratin, a fibrous protein. This buildup of keratin forms the hard cyst visible at birth.
Clinical Significance and Resolution
Epstein Pearls are asymptomatic, meaning they do not cause pain or distress for the infant. They are harmless and do not interfere with feeding or breathing. These cysts are non-mobile and do not grow larger once the baby is born.
No medical treatment or special care is necessary. The cysts spontaneously resolve as the infant feeds, typically within a few weeks to a few months after birth. The mechanical friction created by suckling (from a breast, bottle, or pacifier) causes the thin epithelial layer covering the cyst to break down.
This friction aids in the natural process of epithelial shedding, releasing the keratin buildup. Most cases disappear within one to two weeks, though some may persist for up to three months. Parents should consult a pediatrician only if the nodules remain past six months or if the baby exhibits signs of pain or difficulty feeding, suggesting an alternative diagnosis.