Tiny Bumps in Baby’s Mouth? Don’t Panic—They’re Epstein Pearls

By Dr. Sneha S S, BDS

We all know parenthood is one of the most special periods for everyone. It comes with a lot of love, joy, and, of course, an endless amount of care and concern for your little one. You take care of every single detail, every single change that happens as your little child grows, because it's an instinct as a parent to protect your little one, and sometimes it comes with an add-on topping of worry. But let me tell you a small secret, sometimes some changes don’t need your concern or attention, they are completely normal changes and are harmless. Let’s talk about the tiny little bumps that you might see in your little one's mouth – called Epstein pearls and Bohn’s nodules. Just like any other pearls that you cherish, these tiny bumps are nothing to be worried about. They are a part of the development of your baby, and I’m here to tell you all about it.

What are Epstein Pearls?

Unlike any other normal pearl, Epstein pearls are tiny yellow white bumps that are seen on the newborn's palate (the top part inside the mouth).^[1]They appear in the median palatal raphe due to trapped epithelial remnants along the line of fusion of the palatal halves and are made up of keratin.

Most babies don’t even realize it is there, as they don’t have any symptoms as such. They are not harmful, not painful, and not even infectious.

What are Bohn Nodules?

These look similar to Epstein pearls; Bohn’s nodules are keratin cysts derived from remnants of odontogenic epithelium over the dental lamina or may be remnants of minor salivary glands. They occur on the alveolar ridge, and are more commonly seen on maxilla as compared to the mandible i.e. more common on the upper ridge than the lower ridge.^[3]

They are self-correcting anomalies of the oral cavity that appear during the development of the baby and usually resolve on their own.

What to do about it? NOTHING!!

First of all, sit back and relax; don’t stress. These tiny nodules are harmless, self correcting oral anomalies.

Please don’t rub it, or try to pop it, or in any way try any old home remedies to treat it. The best thing to do is to leave it alone, as fiddling around will only irritate your little one, and every parent knows how difficult it becomes to pacify irritated, unhappy babies.

These usually disappear within the first 3 months of life, are self-healing, and need no dental intervention.

MedBound Times connected with Dr. Rashmi Agarwal, MDS, Pediatric Dentist, for her insights on Epstein Pearls and Bohn nodules:

How to keep your baby's mouth healthy? ^[2]

• Gently wipe your baby's gums softly with a clean, damp cloth once or twice a day.

• Do not put your baby to bed with a bottle, prop it in their mouth, or allow your baby to feed "at will" and avoid sugary drinks.

• Infants normally begin teething between four and six months of age. His/her gums may be red and swollen, and salivary flow may increase. To ease these symptoms, give your infant a clean teething ring that's cold or a cold washcloth to bite on, as the cold temperature helps relieve the symptoms and also feels soothing to your baby.

• As soon as the first tooth comes in, start to use a child's soft-bristle toothbrush, with no toothpaste, in addition to massaging the gum tissues.

• Schedule your child's first dental appointment. Make sure your baby gets the checkup done before their first birthday or within 6 months of eruption of the first tooth.

• Check if your drinking water is fluoridated, talk to your pediatric dentist about infant fluoride supplements, as fluoride is important to keep your baby's teeth healthy and caries free.

When to call a doctor?

Epstein pearls and Bohn's nodules are most of the time harmless, call your pediatric dentist only if you notice:

• Any signs of redness, swelling, or infection around the suspected area where the bumps are seen

• Bleeding or any signs that the bumps seem painful to the baby, or the baby is unusually agitated.

• Bumps that keep growing abnormally in size, or there is an abnormal increase in number or spread to a large area.

References:

1. Marwah, Nikhil. Textbook of Pediatric Dentistry. 4th ed. New Delhi: Jaypee Brothers Medical Publishers, 2019.

2. New York State Department of Health. “Oral Health Care during Pregnancy and Early Childhood: Practice Guidelines.” New York State Department of Health. Accessed May 3, 2025. https://www.health.ny.gov/prevention/dental/birth_oral_health.htm.

3. Shetty, Pushparaja, and Sudhir R. Patil. “Infant Oral Health: An Update.” Indian Pediatrics 51, no. 10 (October 2014): 849–850. Accessed May 3, 2025. https://www.indianpediatrics.net/oct2014/oct-849-850.htm.

Reviewed by Dr. Theresa Lily Thomas, BDS

_MSM/TLT