What Are Epstein Pearls?

What Are Epstein Pearls? 

Epstein pearls are very small cysts that can appear in a baby's mouth that look like tiny, white bumps. They were first described by Alois Epstein in 1880. They generally appear along a baby's gums or along the top of the roof of the mouth. They are seen in 60% to 85% of newborns.

Epstein pearls are benign cysts, meaning they are not dangerous to your baby. They do not require treatment and will go away on their own over the course of a few weeks. Here's what you should know about those little white bumps in your little one's mouth.

When to call a doctor for bumps in your baby's mouth
Verywell / Jessica Olah

Characteristics of Epstein Pearls  

Epstein Pearls contain keratin, which is found in skin and other mucous membranes. They may resemble small pimples in your baby's mouth. They are generally painless. Some characteristics include that they are:

  • Less common in first-born babies
  • May appear on their own or in clusters of 2 to 6 
  • More common in higher birthweight babies
  • More common in Japanese, White, and Black babies
  • Range in size from less than a millimeter to several millimeters in diameter

Identifying Epstein Pearls

Although Epstein pearls are harmless and do not require treatment, you should see a doctor if you are unsure if your baby has Epstein pearls or another condition. It can be difficult to distinguish if what you are seeing in your baby's mouth are actually Epstein pearls.

Bumps in your baby's mouth may be caused by another condition that might need medical treatment, such as thrush (a yeast infection). And in some very rare cases, small white bumps on the gums can turn out to be something a little more surprising—natal teeth. Although it's very rare, some babies are born with developing teeth that can appear in the newborn stages.

You should seek medical attention if the bumps do not go away, seem to get worse, and/or are bleeding, and if your baby appears to be in pain or is refusing to nurse or take a bottle. 

Causes

According to a 2012 study published in British Medical Journal, Epstein Pearls are caused by entrapped epithelium during palate development. This means that skin gets trapped while the baby's mouth structures are still forming in utero.

When a baby's mouth reaches the final stages of development, the sides of the jaw and the palate (roof of the mouth) begin to fuse together. When that happens, some of the layers of skin can get "stuck" and lead to Epstein Pearls. 

Epstein pearls are not preventable, nor caused by anything a parent did or didn’t do during pregnancy.


Treatment 

Sometimes, the friction of breastfeeding, drinking a bottle, or even using a pacifier can help break down the cysts to help them dissolve. You can even give your baby a teething tool to help them rub their gums on the toy to try to break up the pearls.

You should never squeeze Epstein pearls or try to pop the cysts. Not only will that not do any good, but it could introduce harmful bacteria into baby's bloodstream since the gums connect directly to the blood.

A Word From Verywell

It may be surprising—or alarming—to see small, white cysts around your baby's gums or on the roof of their mouth, but don't worry. Thankfully, Epstein pearls are harmless, painless, and go away on their own.

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  1. Diaz de Ortiz LE, Mendez MD. Epstein pearls. StatPearls. Updated October 1, 2020.

  2. Singh RK, Kumar R, Pandey RK, Singh K. Dental lamina cysts in a newborn infant. BMJ Case Rep. 2012;2012:bcr2012007061. doi:10.1136/bcr-2012-007061


  3. Patil S, Rao RS, Majumdar B, Jafer M, Maralingannavar M, Sukumaran A. Oral Lesions in NeonatesInt J Clin Pediatr Dent. 2016;9(2):131–138. doi:10.5005/jp-journals-10005-1349


  4. Kiat-amnuay S, Bouquot J. Breastfeeding keratosis: this frictional keratosis of newborns may mimic thrush. Pediatrics. 2013;132(3):e775-8. doi:10.1542/peds.2012-2796


  5. Heerden WV, Zyl AV. Diagnosis and management of oral lesions and conditions in the newbornSouth African Family Practice. 2010;52(6):489-491. doi:10.1080/20786204.2010.10874032