Signs Of Epstein Pearls In Newborn, Causes, And Treatment

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It is common to find Epstein pearls in newborn babies. They are tiny, white bumps that appear in the baby’s mouth and are also called gingival cysts. Epstein pearls have been named after Alois Epstein, a Czech pediatric physician who first described this cyst.

Approximately 60–85% of newborns have gingival cysts (1). Although Epstein pearls are commonly found on the roof of the mouth or gums in most babies, some male newborns may have it on their penis. No specific treatment is required for Epstein pearls. However, seek medical care to rule out conditions that may resemble Epstein pearls.

Read on to know the causes, symptoms, diagnosis, and treatment of Epstein pearls in newborn babies.

Causes Of Epstein Pearls In Babies

Some studies suggest that Epstein pearls occur due to epithelial cells’ entrapment during palate development (1). It means that the skin gets trapped while mouth structures are developing during the fetal period. While the jaw and the palate (roof of the mouth) fuse during the final phase of mouth development, the skin layer may get stuck and cause tiny cysts.

Epstein pearls contain keratin, a protein found in skin and mucous membranes.

Symptoms And Signs Of Epstein Pearls In Babies

Epstein pearls are usually seen on the gums and roof of the oral cavity

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Epstein pearls appear as whitish-yellow bumps or nodules. A cyst can be one to three millimeters in size and is usually seen on the gums and roof of the oral cavity (1). You may notice a cluster of small bumps than a single bump in most cases.

They do not cause any specific symptoms, such as fever and swelling. Although Epstein pearl may resemble an emerging tooth, the cyst does not cause pain or other teething signs.

Seek medical care if bumps do not disappear within a few weeks, bleed, or grow large in size. You may also consult a pediatrician if the baby shows signs of pain, such as refusing to feed or crying.

Are Epstein Pearls In Newborns Dangerous?

Epstein pearls are not dangerous or painful. They are benign and go away in one to two weeks (2). Cysts may often break due to friction from breastfeeding, feeding bottles, or pacifiers.

Popping or squeezing cysts may result in bacterial infections and increase the risk of complications, such as sepsis.

Usually, these are self-resolving cysts that go away without leaving any scars. It is rare to find Epstein pearls in babies older than three months. However, the cystic epithelium may remain in adult gingiva in some cases.

Diagnosis Of Epstein Pearls In Babies

A pediatrician can diagnose Epstein pearls during an oral physical examination

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A pediatrician can diagnose Epstein pearls during an oral physical examination. Laboratory examinations and imaging tests are usually not required.

An expert’s evaluation can help rule out conditions that could mimic Epstein pearls, such as oral thrush, milia, Bohn nodules (mucosal gland cysts), dental lamina, and natal teeth (teeth present at birth).

Natal teeth may irritate the baby while nursing, and some infants may accidentally swallow a fallen natal tooth. Therefore, if you notice a cyst in a baby’s mouth, consult a pediatrician to rule out the possibility of other conditions, which may cause complications.

Treatment Of Epstein Pearls In Babies

Epstein pearls may not require specific treatment and usually disappear within a few weeks (3). They may dissolve due to friction with the nipples while breastfeeding or drinking from a bottle.

The use of pacifiers and chewing toys may also break the Epstein pearls and gradually dissolve the bump. However, it is not recommended to squeeze or pop the Epstein pearls using fingers or any other instrument.

Epstein pearls in newborn babies are quite common, and they eventually disappear with time. It is advised that you consult a skin specialist or a pediatrician if the symptoms of Epstein pearls do not reduce and instead show signs of bleeding or get bigger in size. It is important to ensure that the baby does not scratch or pop the cysts as it might increase the chances of infection. Although no specific treatment is required for the treatment of Epstein pearls, it is advised that you take proper care of your baby and support the use of pacifiers as they will help dissolve the pearls.

Infographic: Some More Facts About Epstein Pearls

Epstein pearls self-resolve and do not cause any complications for most babies. If your baby has Epstein pearls, refer to this infographic to know more about their appearance and risk factors.

facts about epstein pearls [infographic]
Illustration: MomJunction Design Team

Key Pointers

  • Entrapment of epithelial cells under the skin during palate development may cause Epstein pearls or white bumps in the oral cavity.
  • Epstein pearls are not harmful or painful, and they often disappear within a week or two.
  • You should not pop or squeeze Epstein pearls, and no specific medications are needed.


MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1. Laura E. Diaz de Ortiz and Magda D. Mendez; Epstein Pearls; United States National Library of Medicine
2. Epstein pearls; University of Illinois at Urbana-Champaign
3. Epstein Pearls; MedlinePlus; United States National Library of Medicine
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Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made...
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Dr. Anuradha Bansal

Dr. Anuradha Bansal is a pediatrician and neonatologist working as assistant professor in the Department of Paediatrics at PIMS Jalandhar. She has done her MBBS and MD Pediatrics at GMCH, Chandigarh. Thereafter, she polished her skills as senior resident at MAMC, Delhi. She has also done IAP Fellowship in Neonatology at GMCH, Chandigarh and obtained the membership of the prestigious...
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