Introduction

The use of milk as a vehicle for delivering fluoride for dental caries prevention programmes is a well tried idea and is in keeping with the WHO philosophy. This presentation is based on the study by Pakhomov GN, Ivanova K, Moller IJ and Vrabcheva M, published in 1995.

Background and rationale

This milk fluoridation programme not only ensures that children receive milk on a daily basis but that they have an added advantage of fluoride exposure to protect their teeth against dental caries.

Project Outline

This project commenced in May 1988 in Asenovgrad, a town in the southern part of Bulgaria where half the number of children, nearly three thousand 3-10 years of age received the fluoridated milk in the kindergartens and schools and the other half received milk without fluoride. Fluoridated milk was not available for home use. Estimated daily consumption of milk and fluoride for each child was 200 ml of milk containing 1 mg fluoride (0.5ppm F as NaF) for 180 - 200 days each year.

The dairy providing milk was situated in the nearby town of Plovdic. An adequate amount of sodium fluoride was added to fresh milk, which was packaged in plastic bags. Daily fluoride assays of the milk took place in the dairy.

Clinical examination of 3.5 year olds (approximately 100 children, separate cross-sectional samples) receiving fluoridated milk and 4.5 year olds drinking milk without fluorides in Asenovgrad at baseline in 1988 and at follow-up in 1991 (6.5 and 7.5 years, respectively) were conducted. As a control community, Panaguriche, a nearby town was selected and a sample of 3.5 year olds at baseline in 1988 and after 3 years follow-up in 1991 (6.5 years) were examined. For a 5 year follow-up 8.5 year olds from the study community in Asenovgrad and another control community in Karlovo were examined in 1993 (Panaguriche could not be maintained asa control community).

The natural F in drinking water in all the communities were less than 0.1 ppm and fluoridated toothpastes were not available in any of the communities during the study period.

Achievements

Six and a half-year-old children who had consumed fluoridated milk for 3 years, there was a decrease in the mean dmft per child of 40% and in the mean DMFT of 89% when compared to the control community in Panagurichi.

Dental caries prevalence in children in Asenovgrad (+ F milk) and Panaguriche (no F milk), 1988 (3.5 year olds) and 1991 (6.5 year olds)

Children in Asenovgrad who were 4.5 years old at the start of the study and had been drinking fluoridated milk for 3 years showed a decrease of 44% in the mean dmft and 83% decrease in the mean DMFT at 7.5 years when compared to those who did not get fluoridated milk daily.

Dental caries prevalence in Asenovgrad drinking (+ F milk) and not drinking (- F milk) fluoridated milk, 1988 (4.5 year olds) and 1991 (7.5 year olds)

*dmft versus DMFT:  P < .001

*dmft versus DMFT:  P < .001

After 5 years the dmft index was 40% less and the DMFT 79% less in those children who had participated in the full 5 years of the programme compared to the control community in Karlovo.

Dental caries prevalence (dmft) in 6.5- and 8.5-year-old children after 3 and 5 year's participation in milk fluoridation project in Asenovgrad as compared to Karlovo

Conclusions

These results seem to confirm the caries-reducing effects of milk fluoridation found in previous studies. Unexpectedly large caries reductions observed in this study may however be totally attributed to the fluoridated milk alone. The mere introduction of this project might have led to other changes affecting dental caries, such as improved oral hygiene and better dietary habits.

References

Pakhomov GN, Ivanova K, Moller IJ and Vrabcheva M. Dental caries-reducing effects of a milk fluoridation project in Bulgaria. J Public Health Dent 1995; 55: 234-237.
Milk fluoride project background.