What are Epstein Pearls? – Cause, Symptom & Treatment

Epstein pearl, also known as Enamel pearl, is a dental developmental anomaly that leads to the growth and development of the enamel on abnormal locations such as the tooth root. Typically, the enamel grows in the form of a nodule giving an appearance of a white pearl. Epstein pearl often affects the health of the tooth by contributing to the progression of gum disease.

Usually, Epstein pearls are formed during the developmental stages of the tooth due to entrapment of the skin, which later gets covered by keratin – a layer that lines the enamel. Often Epstein pearls do not show any clinical symptoms or signs. However, in some cases, mild pain or irritability may be present. Epstein pearls are diagnosed on clinical examinations and identified by the typical appearance of enamel in the tooth root.


Often, this developmental condition does not require any treatment. Today’s article will highlight the features of Epstein pearl. Furthermore, we will discuss the cause and treatment of Epstein pearl.

What are Epstein pearls?

Epstein pearls are also known as enamel pearls. It is characterized as a white or yellowish bump that develops on the tooth root near the gum line. Epstein pearls are mistaken for gingival cysts that may affect the newborn baby. in some cases, Epstein pearls may also resemble natal teeth (teeth that babies are born with). (1)

The prevalence of enamel pearl is usually 60-85% in infants. Often, these dental anomalies are painless and harmless.

What causes Epstein pearls?

Epstein pearls usually form when the remnants of the root epithelium and old dentin forming cells fail to separate from the newly created dentin and continue to secrete enamel. This process usually prevents the formation of healthy root covering, leaving a nodule of enamel behind. (3)

Some factors that may influence the development of Epstein pearls in infants include –

  • Babies born to an older mother
  • infants born past their due dates
  • infants born with a higher than average birth weight

What are the symptoms of Epstein pearls?

Epstein pearls typically do not cause any significant symptoms. The white or yellowish bumps may usually grow about one to three millimeters in size. They may affect the appearance of the tooth, especially in the front teeth. In some cases, the infant may feel mild pain or irritation around the affected tooth.

Typically, Epstein pearls are formed in newborn babies. The most common location for the development of Epstein pearls is the upper molar. However, adults may sometimes develop a dental cyst resembling Epstein pearl. (3) Dental cysts differ from Epstein pearls in the following ways –

  • cysts grow overtime gradually
  • large cysts may put pressure on the teeth and weaken the jaw while Epstein pearls remain the same both in size and shape

What is the treatment for Epstein pearl?

Often, Epstein pearls are detected on routine dental radiographic examination. In some cases, the enamel pearl may be mistaken for dental calculus. In newborn babies, the dentist may rule out the presence of natal teeth (teeth that babies are born with). Although this condition rarely occurs, it should be ruled out due to its similar appearance to an Epstein pearl.

If left untreated, it leads to gum disease and inflammation. The dentist might also look at the possibility of oral thrush and rule it out as the white bumps resemble infected yeast lesions in the baby’s mouth. (4)

Usually, asymptomatic Epstein pearls do not require any treatment. However, palliative therapy to treat gum disease and prevent periodontal progression may be followed. In such cases, the dentist may plan the following procedure –

often, Epstein pearls disappear on their own within a week or two after birth. This happens due to continuous friction in the baby’s mouth during breast o bottle feeding. In extreme cases, the dentist may surgically remove the nodular growth from the tooth root. (5)

Once detected, parents need to maintain the good oral hygiene of the infant. Always look out for clinical signs such as chronic inflammation of the gums, bleeding, or pain.

Take away message

Epstein pearls are a unique type of dental developmental anomaly that occurs in infants during the developmental process. It typically occurs when the remnant root tissue of the tooth fails to separate from the newly created dentin and continues to secrete enamel. Therefore, Epstein pearls are mainly seen around the tooth root.


Although Epstein pearls do not cause any severe symptoms, in some cases, the patient may experience mild pain or irritation. Untreated cases of Epstein pearls may lead to gum disease and periodontal breakdown.

Diagnosis of Epstein pearl is based on radiographic studies that show a radiopacity similar to dental calculus near the tooth root. The roots of upper molars are one of the typical locations of Epstein pearls. Usually, Epstein pearls do not require any treatment. However, they may be removed surgically in case of progressive gum disease.


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