Fluoridated milk for preventing dental caries

Summary

Fluoridated milk for preventing dental caries

Insufficient evidence exists to show the effectiveness of fluoridated milk in preventing tooth decay. Tooth decay (dental caries) can cause pain and lead to loss of teeth. Fluoride is a mineral that prevents tooth decay. Fluoride can be used as a public health measure by being added to water supply, salt or milk. Fluoridated milk is often available to children through school milk schemes or national nutritional programmes. The use of such distribution systems can provide a convenient and cost-efficient means of targeted fluoride supplementation. Parents can also have the freedom of choice. The review found that there is insufficient evidence to show the effectiveness of fluoridated milk in preventing tooth decay.

Abstract

Background

Dental caries remains a major public health problem in most industrialised countries, affecting 60% to 90% of school children and the vast majority of adults. Milk provides a relatively cost-effective vehicle for fluoride in the prevention of dental caries.

Objectives

To determine the effectiveness of fluoridated milk, as a means of delivering fluoride on a community basis, for preventing dental caries.

Search strategy

We searched Cochrane Oral Health Group Trials Register (28 April 2005), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 2), MEDLINE (1966 to 17 May 2005), OLDMEDLINE (1950 to 1965), EMBASE (1980 to 2005 week 20), LILACS (1982 to 17 May 2005), BBO (1986 to 17 May 2005), SIGLE (1980 to 17 May 2005), Digital Dissertations (1861 to 17 May 2005) and reference lists of relevant articles. Attempts were made to identify both unpublished and ongoing studies. There were no language restrictions.

Selection criteria

Randomised or quasi-randomised controlled trials (RCTs), with an intervention or follow-up period of at least 3 years, comparing fluoridated milk with non-fluoridated milk. Primary outcome was change in caries experience, as measured by changes in decayed, missing and filled figures on tooth (dmft/DMFT) and surface (dmfs/DMFS).

Data collection and analysis

Inclusion decisions, data extraction and quality assessment were carried out independently and in duplicate. Study authors were contacted for additional information where necessary.

Main results

Two RCTs involving 353 children were included. For permanent teeth, after 3 years there was a significant reduction in the DMFT (78.4%, P < 0.05) between the test and control groups in one trial, but not in the other. The latter study only showed a significant reduction in the DMFT until the fourth (35.5%, P < 0.02) and fifth (31.2%, P < 0.05) years. For primary teeth, again there was a significant reduction in the dmft (31.3%, P < 0.05) between the test and control groups after 3 years in one study, but not in the other. The results could not be pooled because of the difference in concentration of fluoride in the milk.

Authors’ conclusions

There are insufficient studies with good quality evidence examining the effects of fluoridated milk in preventing dental caries. However, the included studies suggested that fluoridated milk was beneficial to school children, especially their permanent dentition. The data need to be supplemented by further RCTs to provide the highest level of evidence for practice.