Epstein Pearls in Newborns: Causes, Appearance, and Natural Resolution

What Are Epstein Pearls?

Small (1–3 mm), white or yellowish keratin-filled cysts on the midline hard palate or gingival ridge of newborns. Also called gingival cysts of the newborn or Bohn's nodules (on buccal/lateral palate).

Etiology

Remnants of dental lamina or palatal epithelial traps during palatal fusion (weeks 10–12 gestation). Normally regress; persistence → cysts.

Clinical Features

• Asymptomatic; do not interfere with feeding.
• Multiple or solitary; firm, non-fluctuant.
• Not associated with systemic disease.

Management

None needed. Spontaneous rupture and resolution within 2 weeks to 3 months. Reassure parents. Do not lance or squeeze (infection risk).

Differential Diagnosis

• Natal/neonatal teeth (erupted teeth at birth).
• Oral candidiasis (wipeable plaques).
• Herpes simplex (vesicles on erythematous base).
• Milia (sebaceous cysts on face).