Fluoridated milk for preventing dental caries

Yeung A, Hitchings JL, Macfarlane TV, Threlfall A, Tickle M, Glenny A-M

Published Online:

October 8, 2008

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 (click to read)

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 Attempts were made to identify both unpublished and ongoing studies.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.

This record should be cited as:

Yeung A, Hitchings JL, Macfarlane TV, Threlfall A, Tickle M, Glenny A-M. Fluoridated milk for preventing dental caries. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003876. DOI: 10.1002/14651858.CD003876.pub2

Assessed as up to date:

May 17, 2005

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Dental caries > Prevention

Demographic:

Children

Cochrane group topics:

Oral Health > ORAL HEALTH > Dental caries > Prevention > Fluoride therapy > Systemic