Milk Fluoridation

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Overview

Milk fluoridation is the addition of fluoride to milk and milk-based products at levels of 2.5 to 5 mg/L [1]. Fluoride forms a soluble complex with the protein fraction of milk and is bioavailable after ingestion. Community-based milk fluoridation programs have been implemented in several countries including Bulgaria, Chile, China, Peru, the Russian Federation and Thailand.

Use and Application

Fluoride is added to fresh, UHT or powdered milk in community schemes. One glass of milk supplemented with fluoride is served to preschool and/or school children once daily on school days. The fluoride levels in milk must be continuously monitored.

Effectiveness and Efficacy

Worldwide cohort studies have consistently reported substantial caries reduction, particularly in the primary dentition with a prevented fraction equivalent to 31%. In systematic reviews requiring randomized controlled trials, the quality of evidence is graded as low [2].

Safety

In a review on safety, milk fluoridation was reported to be safe and the occurrence of mild fluorosis was low [1]. No other adverse effects have been reported but some children may not tolerate the lactose content of milk.

Cost Effectiveness

The cost of milk fluoridation programmes is low, with significant savings per averted caries lesion after four years. Costs vary depending on region, availability of product and distribution.

Recommendations

Fluoridated milk is a community-based alternative for children living in countries with limited access to community dental care and/or where water fluoride is not feasible.

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Key Further Reading