Key Points
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There is cause for concern about the effectiveness of fluoridated milk schemes as a standalone measure for the prevention of caries in children.
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While optimising some process variables looks promising, resources may be more efficiently spent on other fluoride interventions.
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Modelling would inform speculative power calculations for community-based trials of fluoridated milk.
Abstract
Background Dental caries is a public health problem. Fluoridated milk (FM) schemes are used as a preventive measure. The impact of process variables in these schemes is not understood.
Methods Process variable data on the number of days of consumption, attendance, volume consumed, parental consent together with the proportion of children drinking FM at 7- and 11-years old were aggregated from eight schemes in the UK. The impact of process variables was modelled in an 'averaged' scheme (reduced in effectiveness by process variables) and compared with a notional 'ideal' one in which no process variables operate. Parental consent was analysed according to socio-economic groupings.
Results Proportion of days per year FM was consumed: 0.52. Values for process variables were: attendance rate 0.94; proportion of milk consumed 0.91; proportion of children with parental consent at 5 years 0.65; proportion drinking FM at 7 and 11 years respectively 0.54 and 0.27. No clear trends were observed for parental consent across socio-economic groupings.
Conclusion Modelling suggests that due to the cumulative impact of process variables, there is cause for concern about the effectiveness of FM schemes as currently managed in the UK as a standalone public health measure for the prevention of caries.
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Acknowledgements
This work was supported by the Borrow Foundation and Wirral Primary Care Trust. The authors express their thanks to P. D. Foster for mathematics support.
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Foster, G., Downer, M. & Tickle, M. Modelling the impact of process variables in community fluoridated milk schemes on a population of UK schoolchildren. Br Dent J 210, E17 (2011). https://doi.org/10.1038/sj.bdj.2011.388
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DOI: https://doi.org/10.1038/sj.bdj.2011.388
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