White Bumps in a Newborn's Mouth: Epstein Pearls vs. Thrush

Tiny white bumps on a newborn's palate or gums usually go away on their own. How to tell harmless bumps from thrush, a white coating that won't wipe off.

When you peek inside your baby's mouth and find white dots or a white coating, it's easy to feel alarmed. Is a tooth coming in, or is something wrong? Here's how to tell the common white bumps in a newborn's mouth from a white coating that may need a doctor's visit.

Tiny white bumps are really common

Lots of newborns have tiny, grain-like white bumps in the middle of the palate or on the gums. They're leftover tissue from when the mouth was forming, which turned into tiny pockets. These little pockets are called cysts.

Their names depend on where they show up.

• Epstein pearls: along the midline of the palate.
• Bohn's nodules: toward the back of the palate or on either side of the gums.
• Dental lamina cysts: on the top of the gum ridge.

The names differ, but what you do is the same. None of them hurt or need treatment. They usually burst or disappear on their own within a few weeks to a few months after birth. When they sit on the top of the gum ridge, they can look like a tooth coming in, but they aren't teeth.

There's one more thing that's easy to mix up: a white coating on the tongue or inside the cheeks. Most of the time it's just milk residue left after a feed. But sometimes it's thrush, an overgrowth of a type of yeast in the mouth. Thrush looks like a white, cottage-cheese-like coating, and it doesn't wipe off easily.

Leave the bumps alone, gently wipe the coating

If you find white bumps

1. Don't squeeze, scrape, or pop them. Leave them be. Touching them can cause a sore and actually make it hurt.
2. Take a photo and compare every few days to see whether they change in size.
3. Keep wiping the gums with damp gauze after feeds as usual.

If you see a white coating

1. Wet a clean piece of gauze, wrap it around your finger, and wipe gently.
2. If it comes off easily, it's most likely milk residue.
3. If it won't wipe off, or the spot is red or bleeds after wiping, suspect thrush. Stop there and don't rub any more.
4. Also check whether your baby is refusing to feed or has a diaper rash that won't clear up. These can come along with thrush.

If you suspect thrush, there are things you can do at home too. Wash and sterilize bottle nipples and pacifiers after every use. If you breastfeed, check whether your nipples are sore or cracked. Thrush can pass back and forth between mom and baby, so the two are often treated together.

A common mistake is trying a pharmacy product first. Which thrush medicines can be used depends on your baby's age. Don't apply pharmacy products on your own. Check with your pediatrician.

Frequently asked questions

When to see your pediatrician or dentist

• You suspect thrush and your baby is under 4 months old
• There's a white coating and your baby refuses to feed, or it isn't better after 1 week
• There's a white coating along with a diaper rash that won't clear up
• The white bumps keep getting bigger
• A lump on the gum gets in the way of feeding
• Your baby was born with a tooth

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The information in this article is for general educational purposes and does not replace professional dental care. Talk to a dentist about your child's condition.

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