What is Palatal and Gingival Cysts of the Newborn (Epstein pearls, Bohn nodules)?
Throughout history, there have been many studies showing a high occurrence of harmless cysts on the roof of the mouth (palate) in newborns. In 1880, a pediatrician named Alois Epstein first talked about Epstein disease, which refers to small nodules, or raised spots, in a newborn’s mouth. However, it wasn’t until 1967 that Alfred Fromm conducted a large study on these mouth cysts in newborns. He classified the cysts based on their location and what they’re made of, into Epstein pearls, Bohn nodules, and dental lamina cysts and concluded that these bumps are common in infants.
Epstein pearls, Bohn nodules, and so-called ‘gingival cyst of the newborn’ (also known as dental lamina cyst) are quite similar. They’ve often been confused or mixed up over the years. These three types of cysts look similar, have the same cell structure when viewed under a microscope, and develop in the same way. They differ mostly in why they occur.
Nowadays, ‘palatal cysts’ is a term used for Epstein’s pearls and Bohn’s nodules, while ‘gingival cysts of the newborn’ is used to refer to dental lamina cysts. It’s not always possible or necessary to distinguish between these three types of cysts in a clinical setting. They are diagnosed based on what they look like, and they are all treated the same way. However, healthcare professionals who work with newborns should know what these harmless, self-resolving cysts look like to be able to tell them apart from other conditions that need a more intensive approach. These can include congenital epulis of the newborn (a rare soft tissue mass seen at birth) and natal and neonatal teeth (teeth present at birth or that emerge within the first month of life).
What Causes Palatal and Gingival Cysts of the Newborn (Epstein pearls, Bohn nodules)?
Epstein pearls, Bohn nodules, and gingival cysts are different types of bumps that can show up in a baby’s mouth. They are all formed in different ways during the development of the mouth.
Epstein pearls occur when a certain type of cell, called epithelium, gets trapped as the roof of the mouth, or palate, is developing. Bohn nodules are thought to be leftover bits of salivary glands, which make saliva. Gingival cysts are formed from the remains of the dental lamina, which is involved in tooth development.
However, when a bump shows up near the place where the hard and soft parts of the roof of the mouth meet (called the junction), in the middle part of the mouth, it can be hard for doctors to tell whether it’s an Epstein pearl or a Bohn nodule, just by looking. This is because it’s difficult to tell if the bump was formed by trapped epithelium during the development of the palate, or from forming salivary glands.
Risk Factors and Frequency for Palatal and Gingival Cysts of the Newborn (Epstein pearls, Bohn nodules)
Palatal cysts are found in 65 to 85% of newborns, making them relatively common. It’s so common that you can almost consider them a usual part of a baby’s anatomy. On the other hand, gingival cysts are a little less common, seen in about 25 to 53% of newborns.
A study found something interesting about these cysts. They are more common in full-term babies (30%) than in premature babies (9%). The risk of getting palatal and maxillary alveolar cysts increases with the baby’s birth weight, how long the baby stayed in the womb (gestational age), and the baby’s age after birth (post-natal age). However, the study found no significant differences between boys and girls or among different races.
Signs and Symptoms of Palatal and Gingival Cysts of the Newborn (Epstein pearls, Bohn nodules)
Palatal cysts, often known as Epstein pearls and Bohn nodules, are small, painless white-yellow bumps. They tend to be firm, measuring between 1 to 3 mm in diameter. These cysts often appear in groups of two to six, although sometimes there may only be one. The naming of these cysts depends on their location. Epstein pearls are the ones located in the middle of the roof of the mouth (palate), specifically near the junction of the hard and soft areas. Bohn nodules, on the other hand, are found on the inner (buccal) and lower (lingual) surfaces of the gum border (alveolar ridges).
Gingival cysts of newborns look like small white bumps on the top of the gum border (alveolar ridge) and are 2 to 3 mm in diameter. These can be single or multiple cysts. They are typically seen more on the upper jaw (maxilla) than the lower jaw (mandible), and they look like palatal cysts when examined under a microscope.
Children with a cleft (opening) condition also tend to have these palatal cysts. The cysts among such children appear similar to those without the condition, except that in children with a cleft, these cysts tend to be at the edges of the palatal shelves instead of the middle.
Epstein pearls can also be likened to milia, which are small white bumps usually present on the faces of newborns due to the buildup of oils and proteins in the hair follicles.
Testing for Palatal and Gingival Cysts of the Newborn (Epstein pearls, Bohn nodules)
Newborn babies sometimes develop small cysts on their palate (the roof of the mouth) or gums. These are known as palatal and gingival cysts. Doctors can identify these cysts just by looking at them and examining their physical characteristics. There’s no need for any lab tests or imaging like X-rays, because these cysts do not affect the baby’s bones. Therefore, if your baby has such a cyst, you shouldn’t worry about any additional testing or screening.
Treatment Options for Palatal and Gingival Cysts of the Newborn (Epstein pearls, Bohn nodules)
No need to worry if these conditions happen as they naturally go away after a few weeks or months. It’s also rare to see these past the age of three months. Parents shouldn’t be concerned about these conditions. Regular check-ups can provide reassurance and help track the progress.
What else can Palatal and Gingival Cysts of the Newborn (Epstein pearls, Bohn nodules) be?
Doctors sometimes need to differentiate between newborn cysts on the palate and gums, natal and neonatal teeth, and a condition called congenital epulis. It’s important to distinguish between these conditions, as they have different characteristics and treatments.
- Natal and neonatal teeth are rare, usually appearing in the lower front part of the mouth. These teeth can be a bit wobbly because they lack roots or these are too short. These are often removed to avoid the baby swallowing them accidentally. If the baby has other unusual physical features, a genetic evaluation may be needed since natal and neonatal teeth are sometimes related to genetic syndromes like Rubinstein-Taybi, Hallerman-Streiff, Ellis-van Creveld, Pierre-Robin, pachyonychia congenita, short rib-polydactyly type II, steatocystoma multiplex, cyclopia, and Pallister-Hall.
- Congenital epulis is a soft, harmless growth typically found on the upper jaw ridge. It’s present at birth and can even be detected before birth. These growths can interfere with breathing and feeding if they become quite large, but they are usually removed within a few weeks after birth. The growths don’t go away by themselves or reappear after surgical removal.
What to expect with Palatal and Gingival Cysts of the Newborn (Epstein pearls, Bohn nodules)
Palatal and gingival cysts, which are little sacs filled with keratin (a type of protein), in newborns normally disappear or burst on their own, releasing their contents into the mouth within the first few weeks to months after birth. These cysts are rarely seen after the baby is three months old. However, a small amount of the cyst’s lining might stay dormant even in the gums of adults.
It’s thought that these cysts in newborns naturally disappear because the cyst’s wall merges with the mouth’s skin-like lining, which helps empty out the contents of the cyst.
Possible Complications When Diagnosed with Palatal and Gingival Cysts of the Newborn (Epstein pearls, Bohn nodules)
Cysts on the roof of the mouth (palatal) and gums (gingival) are typically found by accident and usually fix themselves. They don’t usually cause any other problems.
Common Features:
- Found by accident
- Usually self-resolving
- Not linked with other complications
Preventing Palatal and Gingival Cysts of the Newborn (Epstein pearls, Bohn nodules)
Your doctor should let you know about something called palatal and gingival cysts of the newborn. These are small, harmless bumps that may appear in a baby’s mouth. They go away on their own, don’t cause pain or any other symptoms, and won’t interfere with feeding or the growth of teeth.