Epstein pearls are small, white or yellowish bumps found inside a newborn’s mouth. These nodules are common, affecting a large majority of infants. They are a form of oral cyst resulting from normal developmental processes in the womb and are entirely harmless. They are benign and resolve without any medical intervention.
What Do Epstein Pearls Look Like
Epstein pearls appear as distinct, firm, white or yellowish-white nodules inside the newborn’s mouth. They are typically small, measuring between 1 to 3 millimeters, about the size of a pinhead. They may present as a single bump or in small clusters, giving them a pearl-like appearance.
These cysts are most commonly located along the midline of the hard palate, the roof of the mouth. This location helps distinguish them from other newborn oral cysts, such as Bohn’s nodules, which are found on the gums. Parents sometimes mistake these hard bumps for an early tooth, but they are simply small sacs filled with a protein.
How These Cysts Develop
Epstein pearls form as a consequence of the natural tissue fusion that occurs during fetal development. The palate, or roof of the mouth, is formed by the joining of two separate halves. During this merging process, small pieces of surface tissue, known as epithelial cells, can become trapped along the fusion line.
These trapped cells form tiny cysts that gradually fill with keratin, a protein also found in skin, hair, and nails. This keratin accumulation creates the white or yellowish bumps visible at birth. These cysts are a normal part of oral development and do not result from infection or poor hygiene.
Clinical Significance and Management
The most significant aspect of Epstein pearls is their benign nature. They are asymptomatic and do not cause the infant pain or discomfort. They do not interfere with the baby’s ability to feed, suck, or swallow. Their high prevalence, occurring in approximately 60% to 85% of all newborns, confirms they are a routine finding in infants.
No treatment or medical intervention is required for Epstein pearls. Attempting to squeeze or remove them is strongly discouraged, as this can cause injury or introduce bacteria. The cysts typically disappear spontaneously within a few weeks or months after birth. They often break down naturally due to friction from feeding or crying, though some may persist for up to three months before fully dissolving.