I found Dr. Steven S. Fuchs’ May JADA article, “Identifying Rosacea: What All Dentists Should Know,” to be very informative and useful for dentists. Rosacea and perioral dermatitis seem to be common dermatologic problems that I personally have noticed more in recent years.

This was the first article I have seen that described perioral dermatitis as a possible variant of rosacea. It is my understanding that dermatologists frequently recommend that their patients with perioral dermatitis discontinue use of toothpastes with pyrophosphates and/or fluorides, citing that these are the most frequent causes.

If fluoride is determined to be the cause of the dermatitis, educating the patient about preventative measures to prevent tooth decay and the possible need for more frequent dental exams would become important. For patients who do not improve after discontinuing use of these ingredients, it would be prudent to ask the dermatologist to consider trying topical metronidazole and allowing the patient to try to resume use of fluoride toothpaste.

I agree with Dr. Fuchs that playing an active role in recognizing and following the management of these types of dermatological conditions is an important contribution that dentists can make to each patient’s comprehensive (physical, emotional and oral) health care.

Karen McCaffery, D.M.D.
Birmingham, Ala.