Understanding Epstein Pearls in Newborns : Causes, Symptoms, and Treatment

1. What are Epstein Pearls?

   Epstein pearls are also known as the gingival cyst of the newborn. These are benign, keratin-filled cysts that commonly appear in the mouth of the infant. These are known to occur in 60-85% of all newborns.⁽¹⁾ These are not harmful and mostly go away within a few weeks without the need for any specific treatment.

   Epstein pearls manifest as small, white, or yellow bumps or spots ranging from 1 to 13 millimeters and are present on the gum and palate. These are named after pediatrician Alois Epstein, as he first described them in 1880.⁽²⁾
   
   

2. Importance of Understanding the Causes, Symptoms, and Treatment

   It is important to have an understanding of the causes, symptoms, and treatment of Epstein pearls because of the following reasons:

   • Knowledge of the characteristics and appearance of Epstein pearls helps in distinguishing them from other oral conditions. It can also be helpful in differentiating harmless cysts from potentially concerning conditions.
   • The new parents might get concerned about the unusual bump or spot in the newborn’s mouth. Knowledge about it can provide reassurance and peace of mind.
   • Unnecessary interventions such as biopsies or surgical removal can be avoided.
   • Education can be provided to the parents about Epstein pearls and their transit nature and reassurance can be provided that no special treatment is needed.
   • Knowledge helps in making proper diagnoses and appropriate treatments.

   Epstein pearls are mostly harmless. In some special cases medical intervention may be needed. Awareness of potential complications can help healthcare professionals in monitoring affected infants and provide intervention if needed.

Why Epstein pearls occur is not fully known, but there are a few theories regarding their development.

• Embryological factors: There are cells lining the mouth and palate. These undergo changes and migrations during the process. This may contribute to the formation of Epstein pearls.
• Entrapped Epithelial Cells: Epstein pearls are small cysts filled with keratin, a protein that forms the outer layer of the skin. These epithelial cells get trapped beneath the surface of the oral mucosa.⁽⁵⁾ This accumulation of keratin within these cysts leads to the characteristic appearance of Epstein pearls.
• Retained Fetal Cells: Some researchers suggest Epstein pearls may result from the retention of fetal cells in the mouth after birth.⁽⁶⁾ During fetal development, certain cells line the oral cavity and it is hypothesized that they may persist postnatally leading to the formation of Epstein pearls.

Epstein pearl is a normal condition in newborns and not indicative of any underlying health condition. They are benign and resolve spontaneously without any specific treatment.⁽³⁾

The symptoms of Epstein pearls include:⁽⁴⁾

• Small round-shaped bumps appear on the gums or the roof of the mouth of the newborn. These bumps can be 1 to 3 mm in diameter.
• The bumps are commonly located along the midline of the gums or the junction between the gums and the palate. These can also be found on the sides of the tongue and inside of the lips.
• Epstein pearls are white and yellow in appearance. They have transparent and pearly quality and resemble small pearls and cysts and are smooth and firm to the touch.
• Epstein pearls get asymptomatic and do not cause any pain or discomfort to the newborn. They also do not interfere with feeding or normal oral functions.

The presence of Epstein pearls is enough for the diagnosis and further testing or medical intervention may not be necessary. Sometimes Epstein pearl is confused with milia, a condition that also causes keratin-filled bumps. If a newborn has Epstein pearls or any oral abnormality is suspected, a healthcare professional should be consulted for proper evaluation and guidance.

Diagnosing Epstein pearls is usually made through visual examination by a health care professional.

The steps involved are:

• Observation: Newborn’s oral cavity is visually inspected. The gums, palate, and other areas where Epstein pearls commonly occur are focused on. The doctor looks for small, white, or yellowish bumps.
• Differentiation from Other Conditions: The appearance and location of the bump are considered to distinguish Epstein pearls from other oral conditions with similar features such as dental cysts, oral thrush, or other types of cysts or growths.
• Medical History and Symptoms: The doctor enquires about the symptoms and concerns that the parents have noticed, which include difficulty in feeding or any other sign of discomfort.

Mostly, the diagnosis of Epstein pearl can be made on the appearance and lack of symptoms. Additional tests or procedures may not be required. It is important for the parents and the caregivers to seek medical advice for any concerns and questions.

Epstein pearls are self-resolving and may not necessarily require any treatment. They disappear without any specific treatment or intervention. However, a few steps can be taken to manage Epstein pearls:

• Reassurance and Education: The doctor provides the parents of the newborn reassurance and education about Epstein pearls. This can help alleviate concerns and anxiety.
• Gentle Oral hygiene: Good hygiene for the newborn is needed even with the Epstein pearls. The gums and the inside of the mouth need to be wiped with a clean and soft cloth after feeding. This helps in removing any accumulated milk or debris and promotes oral health.
• Avoiding Unnecessary Interventions: Popping or squeezing the pearls should be avoided as this can lead to injury or infection.
• Regular Monitoring: The healthcare professional regularly monitors the progress of Epstein pearls. This can help in preventing any related complications.

Treatment is not generally needed for Epstein pearls, but the healthcare provider can provide appropriate guidance and address any specific concerns.

Epstein pearls are mostly harmless, but in most cases, there may be complications or concerns. These include:

• Infection: If bacteria enter the cyst, Epstein pearls can get infected. There may be redness, swelling, pain, and the presence of pus. In such a case, prompt medical attention is needed.
• Abscess formation: Infection can progress to the formation of an abscess, a collection of pus surrounded by inflamed tissue. This may cause localized pain and sometimes fever.
• Persistence Beyond Infancy: Epstein pearls mostly resolve on their own. In rare cases, they may persist for a longer duration and if it does a healthcare professional should be consulted for further evaluation and appropriate management.

The parents or the caregivers should be aware of the potential complications and seek medical advice in case of any concerning symptoms.

Epstein pearls have an excellent outlook and the prognosis is favorable. These are self-resolving and tend to resolve without any specific treatment. In most infants, there is gradual disappearance of small cysts within a few weeks or months after birth.

The normal course of Epstein pearls involves gradual shedding of the keratin and subsequent resolution of the cysts. As the oral cavity of an infant undergoes normal development, the pearls tend to diminish in size or completely disappear.

With regular monitoring of the pearls and routine check-ups, it can be ensured whether or not the pearls are resolving.

Overall, the outlook for Epstein pearls is positive and parents can expect complete recovery without any lasting effects.

Epstein pearls are small, benign, keratin-filled cysts that commonly occur in the mouths of newborns. Normally they do not indicate any health issues.

Understanding the causes, symptoms, and treatment of Epstein pearls is important for accurate identification, parenteral reassurance, avoiding unnecessary interventions, providing education, and guidance, facilitating differential diagnosis, and monitoring for potential complications.

Any concerns or questions about Epstein pearls should be discussed with a healthcare professional for accurate diagnosis and appropriate guidance