Reviewed by Melinda Ratini, DO, MS on June 01, 2021
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. 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. 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. 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.
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.
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.
Milia are tiny lumps or blisters that sometimes come up on babies’ faces soon after birth. They happen when the sweat glands get blocked. The glands get blocked because they aren’t yet fully developed.
Milia are very common.
Symptoms of milia
In newborns, milia look like white lumps or small clear blisters. They come up mostly on the nose and cheeks, but they can appear anywhere on the face. The blisters can break easily and can leave a scaly lump.
Milia are usually less than 1 mm across, but they can measure up to 3 mm.
They don’t hurt or itch.
Does your child need to see a doctor about milia?
Probably not. But if you notice a coloured rash or crusting around the milia, take your child to see your GP.
Treatment for milia
In newborns, you don’t need to treat milia with creams or ointments, because they’ll go away by themselves without any treatment. They usually go away within weeks or months after birth.
They don’t leave scars so don’t try to burst them. Be patient and wait for them to go away naturally.
Milia prevention
Milia are hard to prevent, but it can help to gently wash your baby’s face every day and pat dry. Avoid pinching, squeezing or scrubbing the lumps.
Epstein pearls are harmless. But if your baby is showing signs of pain or irritability, it may be a good idea to follow up with their doctor. Epstein pearls are very common, so their doctor will likely be able to identify these bumps just by their appearance.
Depending on your baby’s symptoms, their doctor might examine their mouth to check for signs of natal teeth. These are teeth that some babies are born with. They’re pretty rare, but they can look very similar to Epstein pearls.
Their doctor might also want to rule out oral thrush. This is a type of yeast infection that can cause small white bumps or a white coating in your baby’s mouth.
Epstein pearls tend to go away on their own within a few weeks after birth, but may persist for several months. If you’re still noticing the bumps after several weeks and they don’t seem to be getting any smaller, make a doctor’s appointment to make sure the bumps aren’t the result of something else.
Epstein pearls are small, harmless cysts that form in a newborn’s mouth during the early weeks and months of development.
The bumps contain keratin, a protein that occurs naturally in human skin, hair, and nails.
Epstein pearls go away on their own within a few weeks of the baby’s birth and are not a cause for concern.
In this article, we look at the symptoms, causes, and treatment of Epstein pearls, as well as when to see a doctor.
Epstein pearls are usually white or yellowish, and they tend to be smaller than 3 millimeters in diameter.
The bumps may be noticeable when a baby opens their mouth to cry or yawn. However, they do not cause any discomfort to the baby and should not interfere with feeding.
Sometimes, people may confuse Epstein pearls with a condition called milia, which also causes keratin-filled bumps. The main difference is their location. Epstein pearls only appear on the roof of the mouth and gums, while milia can occur anywhere on the skin.
Epstein pearls are very common, occurring in up to 60–85% of all newborns. Experts believe that they happen while the roof of the baby’s mouth is forming in the womb.
Epstein pearls do not occur as a result of anything that the woman did during pregnancy. They are also not a sign that anything is wrong with the baby.
There is no way to prevent Epstein pearls.
Epstein pearls do not occur in older children or adults because they are a result of fetal development.
Epstein pearls do not require treatment. In most cases, they slowly dissolve on their own within a few weeks.
Parents or caregivers may wish to consult a doctor if they have concerns that bumps in the baby’s mouth have a different cause.
The following conditions and signs may resemble Epstein pearls, and it can be difficult to distinguish between them. To be safe, it is advisable to see a pediatrician about anything unusual in the baby’s mouth.
1. Oral thrush
In some cases, white spots in a baby’s mouth can be a sign of a fungal infection known as thrush. Oral thrush in babies happens when Candida yeast gets inside the mouth and infects the tissues there.
Oral thrush can cause white patches or bumps in the mouth, including on the inside of the cheeks and the tongue. It can sometimes cause some discomfort or difficulty feeding, but it is not usually serious.
Doctors usually treat oral thrush with antifungal medication. It is important to get treatment, as the infection can spread to the woman’s breast if she is breastfeeding. If this occurs, it can cause cracked nipples and painful breasts.
2. Newborn (natal) teeth
People may mistake Epstein pearls for natal teeth if they appear on the gums. While newborns can have teeth, this is rare and happens in only 1 in every 800 to 6,000 babies.
If a baby is born with one or more teeth, parents or caregivers should discuss this with a pediatrician. Sometimes, the teeth are loose or interfere with feeding. In these cases, a doctor may recommend their removal.
3. Hand, foot, and mouth disease
A virus is responsible for hand, foot, and mouth disease, which is common in children under the age of 5 years. The condition usually clears up on its own within a few days.
Symptoms include sores in the mouth that blister. They may start as small red spots in the back of the mouth. The sores can be painful and may cause fussiness or trouble with feeding.
It is advisable to see a pediatrician if a child has any symptoms of this illness. In some cases, it can lead to dehydration if the baby is unable to take in adequate fluids.
4. Fussiness or other problems
If a baby is unusually fussy, has trouble feeding, or seems unwell, it is a good idea to consult a pediatrician. Although Epstein pearls will not cause any of these problems, it is still best to rule out other possible health conditions.
Many parents and caregivers are concerned when they see Epstein pearls in a baby’s mouth. However, they are painless, not harmful to the baby, and will go away on their own.
If the baby seems to be having trouble feeding or is not well, the parents or caregivers should see a pediatrician to rule out other health concerns.