What Is an Epstein Pearl?

Medically Reviewed on 6/7/2022
Epstein pearl
Epstein pearls are whitish-yellow cysts seen on the gums and roof of the mouth in a newborn baby. These white bumps are harmless and usually go away on their own.

An Epstein pearl is a small, nonprogressive, self-resolving condition often seen in the mouth (oral cavity) of a newborn baby. These manifest as pearly whitish-yellow bumps seen over the gums or roof of a baby’s mouth (palate).

Epstein pearls are small white bumps, typically less than a few millimeters, and do not grow bigger over time.

Epstein pearls are also known as:

  • Bohn’s nodules,
  • Gingival cysts, and
  • Palatal cysts.

The Epstein pearls are named after Dr. Alois Epstein, a Czech pediatrician, who first described them. They are formed during the intrauterine life due to the entrapment of keratin (a type of structural protein present in hair, skin, and nails) within the soft and hard palates. 

  • These are often seen in a cluster of two to six pearls.
  • Sometimes, a single pearl may look like a baby tooth breaking through and worry the parents.
  • Additionally, the pearls often feel firm to the touch and can be hard to tell the difference.

Epstein pearls are harmless. They do not cause pain or feeding problems in a baby. They will spontaneously disappear within two to three months and will not hamper the baby’s regular teething. The lesions are hardly ever seen after three months of age.

If the baby cries frequently or refuses to feed, it is not due to these pearls. It is better to take them to the doctor.

Can you pop an Epstein pearl?

No, one should not try to pop or rupture the Epstein pearl. Doing so can cause bleeding, irritation, infection, or even gum damage. Also, people may inadvertently introduce germs into the baby’s mouth and bloodstream, causing sepsis, a serious systemic infection.

How do you treat an Epstein pearl?

Most of these cysts involute or spontaneously rupture in a few weeks from appearing. No ointment, medication, or surgical procedure is required to treat Epstein pearls.

There is no test to detect an Epstein pearl. The doctor will examine the roof of the mouth and mouth cavity to diagnose the condition. Most of these cysts will eventually get smaller and go away in the next few weeks.

What are precocious teeth?

Unlike Epstein pearls, precocious teeth are actual teeth. These may be present at birth (natal teeth) or may grow during the first month of birth (neonatal teeth). These precocious teeth are uncommon and may often accompany congenital defects.

Natal teeth are uncommon and seen on the lower gum, where the central incisor teeth will later appear. They may be wobbly because they have incomplete root structures.

  • The natal teeth may cause irritation and injury to the infant’s tongue when nursing and hence, require removal.
  • These teeth can also be uncomfortable for a nursing mother.
  • As such, the teeth are often removed shortly after birth because they are a choking hazard (surgery is done before the baby is discharged).

Consult your doctor in case of neonatal teeth. The doctor will take dental X-ray scans to determine if the teeth are normal milk teeth or extras, as well as the extent of development of the root, enamel, and dentin and their relationship to other teeth.

Sometimes, conservative treatments for precocious teeth may suffice, such as:

  • Changes in feeding technique
  • Smoothing sharp edges of the tooth
  • Application of a special resin over the edge of the tooth, so the tongue glides over
  • Applying protective rings to the gums
  • Dental hygiene including topical fluoride application


Newborn babies don't sleep very much. See Answer

Do babies get sick when teething?

Teething may cause slight discomfort in babies; however, if a child is sick for a long time, it may be due to another condition.

Teething may cause slight discomfort in babies. However, if the child appears to be sick, fussy, or cranky for a longer time, it can be due to conditions other than teething. 

Teething usually begins around four to eight months and continues until 30 to 36 months of age. Initially, the lower front teeth appear, and finally, the last set of molars appear.

Some babies may experience the following symptoms during the teething period:

  • Increased tendency to put things in their mouth
  • Irritability or fussiness that comes and goes
  • Disrupted sleep
  • Swelling or inflammation of the gums
  • Drooling
  • Loss of appetite
  • Rash around the mouth
  • Mild temperature (never higher than 100 °F)
  • Diarrhea
  • Increased biting
  • Gum-rubbing
  • Ear-rubbing
  • Is less interested in solids
  • Chews on toys or other objects
  • Brings hands to mouth

If your baby experiences these symptoms, do not blame it only on teething and delay treatment. The child could be sick and needs immediate medical intervention. Symptoms include:

  • Fever: If the fever reaches 101 °F, immediately contact the pediatrician because it could be a sign of infection.
  • Diarrhea: If the stool becomes watery and persists for more than a day, it could be a sign of a more severe infection. Contact your child’s pediatrician if you observe watery stools.
  • Prolonged fussiness: If your baby constantly cries to a point where they can’t be consoled or find it difficult to sleep, contact your pediatrician immediately.
  • Rashes over the body: Rashes spreading across their torso, arms, or legs should be brought to your pediatrician’s attention.
  • Runny nose: Runny nose that lasts for more than 10 days isn’t a sign of teething but for a sign of infection. You should immediately contact the pediatrician.
  • Cough: If your baby has a continuous cough with a high fever and cold, it could be a sign of flu. You should contact your infant’s doctor immediately.
  • Cheek rubbing and ear pulling: Please contact your doctor if your baby’s ear pulling or cheek rubbing persists or is accompanied by a high fever. It may indicate an ear infection.

These could be signs of an infection that may simultaneously occur with teething. It is necessary to consult a pediatrician if you find any unusual symptoms other than these symptoms.

Medically Reviewed on 6/7/2022
Diaz de Ortiz LE, Mendez MD. Epstein Pearls. [Updated 2021 Jul 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. <https://www.ncbi.nlm.nih.gov/books/NBK493177/>.

DermNet New Zealand. Natal and neonatal teeth. <https://dermnetnz.org/topics/natal-and-neonatal-teeth>.

Children's Hospital Los Angeles. Your Infant is Teething: Know the Signs and Symptoms. July 10, 2020. <https://www.chla.org/blog/rn-remedies/your-infant-teething-know-the-signs-and-symptoms>.