Effectiveness of Fluoridated School Milk as a Public Health Measure

Objective: To assess the impact of process variables (consent levels and drop out) which affect the optimal delivery of a community fluoridated milk scheme, on the effectiveness of the scheme in reducing caries in the primary and permanent dentition. Methods: Data were collected from community fluoridated milk (FM) schemes in the UK to determine the level of parental consent for drinking fluoridated milk at 4 years of age and the subsequent loss of pupils to the scheme at 7 and 11 years of age. Sensitivity analysis was used to model the caries reduction that could be expected in a population participating in a scheme. These process variables were analysed further according to socio-economic groupings. The Index of Material Deprivation (IMD) score was determined for each participating school and sorted into quintiles of IMD. Decision trees were constructed to compare the scenarios for consent and loss of pupils for the highest, middle and lowest quintiles of IMD. Results: Initial findings gave an estimated average of 58% of 4–years-olds with parental consent. This value decreased as pupils got older and left the scheme. By 7 and 11 years of age, an estimated average of 42% and 25%, respectively, of pupils still drank fluoridated milk. The sensitivity analysis gave estimates of caries prevalence. A modest reduction in caries prevalence was observed in the primary dentition of 8-year-olds. The decision trees did not show a correlation between consent or loss of pupils to schemes and socioeconomic status. Conclusion: Level of positive consent and loss of pupils to the programme have a significant impact on the effectiveness of community FM schemes. Socioeconomic status in England does not appear to affect consent or loss of pupils to schemes. (Study is partially funded by The Borrow Foundation)