Introduction
Cysts can be broadly categorized as developmental cysts and inflammatory cysts. Developmental cysts can arise during embryogenesis (formation of the fetus) or even in the later stages of life. Palatal cysts and gingival cysts are two commonly encountered developmental cysts found in newborns or infants. Both are distinct clinical entities; however, they are innocuous and self-resolving and do not require invasive approaches.
What Are the Palatal Cysts of Newborns?
Palatal cyst of the newborn refers to either Epstein's pearls or Bohn's nodules of the oral cavity in an infant, while gingival cysts of the newborn are also referred to as dental lamina cysts. These palatal cysts can be seen as either whitish or yellowish soft, non-fluctuant papular lesions that generally do not exceed more than 3 millimeters.
Epstein's pearls are keratin-filled nodules that present clinically only along the mid-palatine raphe, whereas Bohn's nodules are found scattered throughout the hard palate. The origin of these Epstein pearls may be attributed to the entrapment of epithelial remnants along the line of fusion during embryogenesis. In contrast, Bohn's nodules are from the remnants of salivary glands. Also, Epstein's pearls appear more white and may be quite large compared to the smaller Bohn's nodules. Out of these two cystic lesions palatally, Epstein pearls are known to have a higher prevalence. Both the terms have been used interchangeably in the literature, and since both cysts have an increasing preference for the palate, palatal cysts would be a more preferred term. Palatal cysts (Epstein pearls or Bohn's nodules) commonly tend to appear in almost 65 % to 85 % of newborns and can be considered physiologic variation because of the frequency with which they occur in most infants. These cysts may appear either in groups or even be isolated in the palatal region of newborns. Also, they are painless and do not cause any oral discomfort during feeding or while sucking and hence may not be noticeable until checked by a dentist. These lesions are not only benign but also self-limiting.
What Are Gingival Cysts of Newborns?
Gingival cysts are also called dental lamina cysts. They arise from the remnants of the dental lamina. Gingival cysts are slightly less prevalent than palatal cysts, with a clinical prevalence of around 25 % to 53 % in newborns. Remnants of the dental lamina are hypothesized to remain within the alveolar ridge mucosa after tooth development. Subsequently, these cells proliferate to form keratinized cysts in the gingiva of the newborn. Gingival cysts of the newborn appear mainly as small lesions that do not usually exceed two to three millimeters in diameter and may be either isolated or multiple. These whitish papules occurring on the crest of the alveolar ridge give a confirmative diagnosis of the gingival cyst. They are also most commonly found in the maxilla or upper jaw than in the lower jaw.
Histopathologically, both palatal and gingival cysts show the same histologic features; hence the diagnosis by the dentist would be purely based on the location of the cyst. Histopathological features of these cysts include a keratin-filled cystic content lined by parakeratinized stratified squamous epithelium.
What Is the Management of Palatal and Gingival Cysts of Newborns?
Seldom any treatment is needed for both palatally or gingivally occurring cysts of the newborn as they tend to spontaneously regress within a few weeks or, at maximum, in a few months. However, if they persist for many months and are a source of discomfort to the child, then a differential diagnosis needs to be established by the dental surgeon.
Also, because of the self-limiting nature of these cysts, it is crucial to reduce or alleviate parental apprehensions by reassuring them about the spontaneous regression of the cyst. Parents should also be recommended follow-up appointments to keep a check on the infant. The clinician should also ideally explain to the parents that the palatal and gingival cysts of the newborn are benign. These lesions will not interfere with feeding or primary tooth eruption unless symptomatic.
Conclusion
To conclude, healthcare professionals must have sound knowledge to diagnose and distinguish these benign, self-resolving lesions in newborns or infants. They are incidental discoveries that barely cause any complications or require treatment. However, it is essential that parents are reassured regarding its benign and innocuous nature and that these cysts will not interfere with their feeding or teething.
