Discovering tiny white or yellowish spots in your newborn’s mouth can be a cause for concern for many parents. However, in most cases, these harmless cysts are known as Epstein pearls. In this blog, we will explore everything you need to know about Epstein pearls in newborns, including their causes, how to recognise them, treatment options, and when to seek medical advice. By the end of this article, you’ll understand how common they are, how to care for your infant, and why there’s usually no reason to worry.

What Are Epstein Pearls in Newborns?

Epstein pearls in newborns are small, firm, white or yellow cysts that appear on the roof of the mouth (palate) or along the gum line. These cysts are made of keratin, the same protein that forms hair and nails. They are present in about 60% to 85% of newborns and are completely harmless. They are named after Dr. Alois Epstein, a Czech paediatrician who first described these oral cysts in the late 19th century during his study of neonatal development. These cysts are also sometimes referred to as palatal cysts, gingival cysts, or Bohn’s nodules, depending on their specific location in the mouth.

Key Points:

• They usually appear shortly after birth.
• Epstein Pearl’s infant cases do not require treatment.
• These cysts are not painful and do not interfere with the feeding process.

Epstein pearls are a normal part of a newborn’s oral development and will resolve on their own within a few weeks.

How Common Are Epstein Pearls?

Epstein pearls are very common among infants. According to studies, nearly 4 out of 5 newborns have Epstein pearls at birth. These tiny cysts are a normal occurrence and are especially common in full-term babies.

There is no link between Epstein pearls and poor health. They are considered a natural result of the baby’s development.

Epstein Pearls Causes

Epstein pearls form during fetal development. As the baby’s mouth forms, layers of skin can get trapped during the fusion of the palate. These trapped skin cells form small cysts filled with a protein called keratin.

Causes include:

• Fusion of the palatal shelves in utero.
• Trapped epithelial tissue during oral cavity formation.
• No infection or trauma involved.

These causes are natural and not influenced by a mother’s behaviour during pregnancy.

What Do Epstein Pearls Look Like?

Epstein pearls are often confused with Bohn’s nodules due to their similar appearance. However, they differ in location—Epstein pearls typically occur along the midline of the palate, while Bohn’s nodules are found on the gums. Both are benign and appear as small, white or yellow cysts in newborns.

Epstein pearls in newborns are easily identifiable visually.

Characteristics:

• Small (1 to 3 mm in diameter).
• Firm to the touch.
• White or yellowish.
• Located on the palate (roof of the mouth) or gumline.

They can resemble teeth, but are not teeth. Do not confuse Epstein pearls 3 month old with teething symptoms.

If you’re unsure, refer to Epstein pearls pictures online or consult a paediatrician.

How Are Epstein Pearls Diagnosed?

Diagnosis is straightforward and typically made during a newborn’s first medical exam.

Diagnosis involves:

• Visual inspection by a paediatrician.
• No need for X-rays or blood tests.
• Distinguishing from other conditions like oral thrush, natal teeth, or milia.

Doctors often reassure parents that the bumps are normal and will disappear.

Should You Be Concerned?

Epstein pearls infant cases are not a cause for concern. They are painless, harmless, and require no medical intervention.

You should not worry unless:

• The bumps persist beyond 6 months.
• They interfere with feeding.
• There are signs of infection or bleeding.

In such rare cases, a visit to a paediatrician is advised.

Epstein Pearls Treatment

No specific Epstein pearls treatment is required. These cysts disappear on their own as your baby grows.

What to do:

• Do not touch or attempt to pop them.
• Maintain good oral hygiene.
• Wait for natural resolution (usually 1 to 3 weeks).

Doctors generally advise parents to observe and keep the baby comfortable.

Home Remedies for Epstein Pearls

While no treatment is needed, some parents prefer to maintain oral hygiene gently at home:

Safe home care tips:

• Use a clean, damp gauze pad to wipe the baby’s gums.
• Avoid any gels, ointments, or oils unless recommended.
• Do not use fingers or cotton swabs to press or scrub.
• Keep the baby hydrated and well-fed.

These simple methods can prevent the area from becoming irritated.

Epstein Pearls by Age

Epstein Pearls 3 Month Old

Most Epstein pearls resolve by the first month. If Epstein pearls in a 3 month old persist, it’s usually still harmless but worth monitoring.

Epstein Pearls 6 Month Old

If cysts remain for six months, it could indicate a different condition. See a paediatrician to rule out other oral issues.

Epstein Pearls Adults

Epstein pearls are not found in adults. Similar oral cysts in adults should be evaluated for different causes, such as mucoceles or other benign growths.

Epstein Pearls vs. Bohn’s Nodules: What’s the Difference?

“Newborn gingival cysts” is a broad term that covers three similar types of harmless cysts found in babies’ mouths. All three contain keratin, a protein in skin and nails, and look alike, so healthcare providers sometimes use their names interchangeably. The main difference between them is their location in the mouth.

The three types of newborn gingival cysts are:

• Epstein Pearls: These are the most common. They appear as small bumps along the centre of your baby’s palate (the roof of the mouth) or sometimes on the gums. Epstein pearls develop during fetal growth when the roof of the mouth fuses.
  
• Bohn’s Nodules: These bumps usually form along the gums, often on the lip or tongue side. They are more common on the upper jaw than the lower. Experts believe Bohn’s nodules come from leftover small salivary gland tissue.
  
• Dental Lamina Cysts: These cysts form on your baby’s gums and can look like unerupted baby teeth. They develop from leftover fragments of the dental lamina, a special tissue involved in tooth formation before birth. These cysts are also harmless and go away on their own.

All these cysts are normal parts of oral development in newborns and do not cause pain or require treatment.

When to See a Doctor

Most cases do not need medical attention. However, seek help if:

• The cysts do not disappear after 3 to 6 months.
• Your baby has feeding problems.
• There is swelling, pain, or discolouration.

Doctors can ensure there’s no underlying oral issue.

Summary: Key Takeaways on Epstein Pearls in Newborns

Epstein pearls in newborns are common, painless, and completely harmless cysts that appear on the roof of the mouth or gums. They are caused by natural developmental processes and are composed of keratin. Found in around 60% to 85% of infants, these cysts don’t require medical treatment and typically resolve on their own within a few weeks. Maintaining gentle oral hygiene can help ensure comfort. If the cysts persist beyond six months or cause feeding issues, it’s best to consult a pediatrician.