New parents often discover tiny, white or yellowish bumps in their newborn’s mouth known as Epstein pearls. These harmless nodules are a frequent observation, affecting a large percentage of infants shortly after birth. This article explains what Epstein pearls are, details the biological reason for their occurrence, and discusses why they do not require medical intervention.
Defining Epstein Pearls
Epstein pearls are small, firm cysts that appear in the oral cavity of newborn babies. They are named after the Czech pediatrician Alois Epstein, who first described them. These nodules are classified as epithelial inclusion cysts, which means they are small sacs of trapped skin-like cells. They are present in a significant number of newborns, with prevalence estimates ranging from 60% to 85% of all infants.
Visually, they look like small, pearl-like dots that are white or yellowish-white in color. They are minute, typically measuring only one to three millimeters in diameter. The most characteristic location for these cysts is along the median palatal raphe, the line running down the center of the roof of the mouth where the two halves of the palate fuse.
The Developmental Cause
Epstein pearls represent a normal anatomical variation resulting from the process of fetal development. They form when small fragments of epithelial tissue become entrapped during the formation of the palate. This occurs as the two sides of the palate, known as palatal shelves, move toward the midline and fuse together.
During this fusion, tiny pieces of epithelium can be inadvertently sealed beneath the surface of the newly joined palate. These trapped remnants then begin to accumulate keratin, a protein found in skin, hair, and nails. This accumulation causes the formation of the small, hard cysts visible at birth. This embryological process confirms Epstein pearls are a normal finding, not a sign of disease or pathology.
Clinical Significance and Management
The presence of Epstein pearls is considered a benign, self-limiting condition that does not require medical treatment. These cysts are asymptomatic, meaning they do not cause pain, discomfort, or interfere with feeding. Parents should be reassured that the bumps will not harm the infant or affect their ability to nurse or take a bottle.
Epstein pearls resolve on their own, usually within the first few weeks or months of life. The cysts spontaneously rupture or dissolve due to friction within the baby’s mouth from actions like nursing, bottle feeding, or crying. This abrasion gradually breaks down the thin layer of tissue covering the keratin-filled cyst, allowing the contents to dissipate. Because they disappear naturally, attempting to squeeze or rupture the cysts is discouraged, as this action could introduce bacteria and cause infection.
It is helpful to distinguish Epstein pearls from other similar newborn oral findings, such as Bohn’s nodules or natal teeth. Bohn’s nodules are also keratin-filled cysts, but they are found on the gum ridges and arise from remnants of salivary gland tissue. Natal teeth are rare, true teeth present at birth, which may require removal if they are loose or interfere with feeding. Epstein pearls, located mainly on the midline of the palate, are distinct and transient, serving as a cause for parental reassurance.