Epstein Pearls in Newborns: What Parents Need to Know

Jun 13, 2024 | 4 min read

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Epstein pearls are small, benign cysts that commonly appear in newborns' mouths. These harmless bumps, made of keratin, typically resolve on their own within a few weeks to months. They do not cause discomfort or health issues and require no treatment.

epstein pearls

What Are Epstein Pearls?

Epstein pearls are tiny, benign cysts that appear in the mouths of newborn babies. These white or yellowish bumps are commonly found along the gums or on the roof of the mouth. Made of keratin, a protein present in hair, skin, and nails, Epstein pearls are harmless and typically resolve on their own without any need for medical treatment.

According to the Europe PMC journal, Epstein pearls are very common, appearing in approximately 60% to 85% of all newborns. Their frequent occurrence makes them a normal part of many infants' early lives. Importantly, Epstein pearls are not a sign of any health issue and usually disappear within a few weeks to months.

epstein pearls appearance


Epstein pearls are small, firm nodules that are white or yellowish in color. They are typically less than a few millimeters in diameter. These cysts can appear alone or in clusters of several nodules. While their appearance may concern parents, it’s important to know that Epstein pearls do not cause any pain or discomfort to the baby.

Resemblance to Emerging Teeth

One of the main reasons Epstein pearls can cause concern is their resemblance to emerging baby teeth. They appear as small, firm bumps along the gums, which can be easily mistaken for teeth breaking through.

However, unlike teeth, Epstein pearls are temporary and will go away on their own. If you’re ever unsure whether you're seeing Epstein pearls or early teeth, consulting with a pediatrician can provide clarity and peace of mind.

epstein pearls resemblance

Causes of Epstein Pearls

Epstein pearls form due to a natural biological process that occurs during fetal development. These cysts are composed of keratin, the same protein that makes up our hair, skin, and nails. Let's explore the detailed process behind their formation.

During fetal development, the mouth and palate undergo significant changes. As the fetus grows, the oral tissues start to fuse together. This fusion is crucial for the proper formation of the mouth. However, sometimes small amounts of tissue get trapped during this process. These trapped tissues eventually form into tiny cysts filled with keratin, known as Epstein pearls.

How Oral Tissues Become Trapped During Fetal Development:

  • Development of the Palate: The roof of the mouth, or the palate, forms from two separate structures that gradually fuse together in the middle. If small pieces of tissue become trapped during this fusion, they can develop into Epstein pearls.
  • Keratin Buildup: The trapped tissues produce keratin, which fills the cysts and gives them their characteristic white or yellowish appearance.

Diagnosing Epstein Pearls

Diagnosing Epstein pearls is straightforward for healthcare providers. These cysts have distinctive characteristics that make them easy to identify during a routine examination. However, it's essential to differentiate them from other conditions that might look similar.

How Healthcare Providers Diagnose the Condition

Healthcare providers typically diagnose Epstein pearls through a simple visual examination of the baby's mouth. The distinctive appearance of these cysts—small, white or yellowish, and firm to the touch—allows for easy identification.

Differentiating from Other Conditions

While Epstein pearls are benign and harmless, other oral conditions in newborns might require different approaches. Here are some conditions that healthcare providers consider:

  • Thrush: This is a common fungal infection that can cause white patches in the mouth. Unlike Epstein pearls, thrush may cause discomfort and needs treatment with antifungal medication.
  • Natal Teeth: Some babies are born with one or more teeth, which can be mistaken for Epstein pearls. Natal teeth are actual teeth and can cause discomfort or feeding issues, sometimes requiring removal.
  • Other Oral Cysts: Other types of benign oral cysts can appear similar to Epstein pearls but may be located differently or have different characteristics.

Symptoms Requiring Differential Diagnosis

  • Persistent white patches that do not match the typical appearance of Epstein pearls.
  • Symptoms such as discomfort, feeding difficulties, or visible signs of infection.
  • Any growths that change in size or appearance over time.

Using these criteria, healthcare providers can confidently diagnose Epstein pearls and provide reassurance to parents. If you have any concerns about your baby's oral health, Symptom Checker can offer initial guidance, but it's always best to consult a healthcare professional for an accurate diagnosis and advice.

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Treatment and Management

Epstein pearls are a benign condition, meaning they are harmless and typically do not require any medical intervention. Attempting to treat or remove Epstein pearls can cause unnecessary stress and potential harm to the infant.

  • Duration: Most Epstein pearls disappear within the first few weeks of life, although some may persist for up to three months.
  • Progression: The cysts may reduce in size gradually until they are no longer visible. There is no need for parents to monitor them closely, as this process is entirely natural.


Epstein pearls are a natural occurrence and cannot be prevented. They form as a result of normal developmental processes during fetal growth. Since they are not caused by any external factors, there is no way to prevent their formation.

When to Consult a Medical Professional

  • Persistent Cysts: If the cysts do not resolve within three months.
  • Growth or Change in Appearance: If the cysts grow larger or change in appearance over time.
  • Discomfort or Feeding Issues: If the baby shows signs of discomfort, pain, or has difficulty feeding.
  • Additional Symptoms: Any other unusual symptoms, such as redness, swelling, or signs of infection.

Frequently Asked Questions

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Epstein pearls are a common and harmless condition in newborns. These small, white or yellowish cysts on the gums or roof of the mouth resolve on their own within a few weeks to months. They do not cause discomfort or long-term issues for the baby. If you have concerns or notice unusual symptoms, consult a healthcare professional.

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