Epstein pearls are small, harmless cysts that form in a newborn’s mouth during the early weeks and months of development. They contain keratin and usually go away within a few weeks.

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.