Observing any unfamiliar finding in a newborn’s mouth can understandably cause concern for new parents. These tiny, white or yellowish bumps are known as Epstein pearls, a very common and harmless occurrence in infants. They are a type of cyst that develops during the baby’s formation in the womb. These benign findings are considered a normal part of neonatal oral development and require no active medical intervention.
Defining Epstein Pearls
Epstein pearls appear as small, firm, pearl-like nodules found in the mouth of a newborn. They are typically white or yellowish-white and measure between one and three millimeters in diameter. These bumps are most often located along the midline of the hard palate, which is the roof of the mouth. Studies show that Epstein pearls are extremely common, affecting up to 85% of all newborns.
The nodules are asymptomatic, meaning they do not cause the baby pain, discomfort, or difficulty with feeding. They are filled with keratin, the naturally occurring protein that makes up hair, skin, and nails. Because of their appearance, they are sometimes mistaken for early emerging teeth or an oral infection like thrush. Their distinct location on the palate helps medical professionals differentiate them from other oral findings.
How They Form and Similar Conditions
Epstein pearls are classified as epithelial inclusion cysts, arising from trapped tissue during development. They form during the fetal stage when the two halves of the palate fuse together. During this fusion, small fragments of epithelial tissue become enclosed along the seam, which then fill with keratin over time. This developmental process is natural and does not indicate a problem with the baby’s growth or health.
It is important to distinguish Epstein pearls from two other similar conditions in a newborn’s mouth. Bohn’s nodules are keratin-filled cysts found on the gumline (alveolar ridges), originating from remnants of minor salivary gland tissue. Congenital or natal teeth are actual teeth that have erupted before or shortly after birth. This rarer finding may require evaluation if the teeth are loose or interfere with feeding. All three conditions are generally harmless, but they are differentiated by their specific location and origin.
Resolution and When to Consult a Doctor
No treatment is necessary for Epstein pearls because they are a self-limiting condition that resolves on its own. They are temporary and typically disappear within the first few weeks or months after birth. The friction created by the baby’s tongue, nursing, or bottle feeding naturally causes the cysts to rupture and dissolve. They are rarely observed in infants older than three months.
Parents should avoid attempting to rub, squeeze, or pop the nodules, as this can introduce bacteria and lead to irritation or infection. While the bumps are benign, a consultation with a pediatrician or dentist is warranted under specific circumstances. If the spots appear to grow significantly, persist past a few months, cause difficulty with feeding, or are accompanied by fever or pain, a medical evaluation is recommended.