What Are Epstein Pearls?

Epstein pearls have become a common name for white bumps in your baby’s mouth. They can be deceiving since they resemble brand new baby teeth. Epstein pearls are like a benign form of acne but they occur in the mouth. They are completely harmless and will eventually take care of themselves, so don't worry about them affecting your baby's health.

What Do Epstein Pearls Look Like?

Epstein pearls look like white bumps underneath the skin. They are opaque whitish-yellow cysts or lesions that can form on your baby’s gums or the roof of their mouth. 

Epstein pearls are small, typically less than a few millimeters in diameter. They should not get bigger over time. If you noticed the bumps in your baby’s mouth getting bigger, you should call your doctor. 

Epstein pearls can appear as a single cyst or in groups of two to six lesions. Their development and placement seems to be random, but neither is worse than the other. 

What tends to concern parents is a single Epstein pearl on the gums. It can often look like a baby tooth breaking through the gum. Since Epstein pearls are firm to the touch, it can be hard to tell the difference. 

Epstein pearls are otherwise asymptomatic. They’re benign and cause no problems with feeding or teething. If your baby seems to experience any discomfort, they should be taken to a doctor

What Causes Epstein Pearls?

Epstein pearls are quite common in newborns. Around 80% of newborns will have Epstein pearls. They usually don’t develop them after 3 months old. 

Epstein pearls are caused by a build-up of keratin in the soft and hard palates. Keratin is the material your hair and nails are made of. They're similar to milia on the face, which are a harmless build-up of skin cells. 

There’s no clear cause for this. It’s theorized that tissues get trapped during gestation when the palate develops. Then, the Epstein pearls appear under the skin of the mouth after birth. 

How Are Epstein Pearls Diagnosed?

Your doctor will perform a simple physical exam of your baby’s mouth to confirm the white bumps aren’t new teeth. While they can typically diagnose Epstein pearls during a physical exam, certain symptoms may suggest another condition.

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Bohn nodules. These cysts appear on the roof of the mouth on the ridge just behind the front teeth. These are lesions on mucous glands and are typically grayish-white. 

Dental lamina cysts. These lesions are very similar to Epstein pearls. They are typically more transparent and slightly bigger, but they are similarly benign and fade after a short time. 

Congenital epulis. This rare condition is categorized by a benign tumor. This type of tumor is attached to the tissue via a stem-like appendage. For an unknown reason, they are ten times as likely to form in infant girls than boys. 

This growth can cause complications with eating and breathing. Surgical removal is required, but it’s highly unlikely that congenital epulis will return. 

How Do You Treat Epstein Pearls?

Epstein pearls clear up on their own within a few weeks and up to three months. They typically fade away or rupture, releasing the backed-up keratin. 

Even though they will rupture eventually, you should never attempt to speed up the process and rupture an Epstein pearl yourself. This can lead to irritation, infection, and inflammation. Your doctor won’t attempt to remove them either, as medical intervention for an Epstein pearl is unnecessary stress to put on your baby for this condition. Again, this growth will not affect your baby's health or ability to feed, so just allow them to heal on their own.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on June 01, 2021

Sources

SOURCES:
Diaz de Ortiz, L., Mendez, M. StatPearls. StatPearls Publishing, 2020.
Journal of Oral and Maxillofacial Pathology: “Congenital epulis of the newborn.”
Mount Sinai: “Epstein pearls.”

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