Critique of the review of 'Water fluoridation for the prevention of dental caries' published by the Cochrane Collaboration in 2015.

The Cochrane Review on water fluoridation for the prevention of dental caries was published in 2015 and attracted considerable interest and comment, especially in countries with extensive water fluoridation programmes. The Review had two objectives: (i) to evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries, and (ii) to evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis. The authors concluded, inter alia, that there was very little contemporary evidence, meeting the Review's inclusion criteria, that evaluated the effectiveness of water fluoridation for the prevention of dental caries. The purpose of this critique is to examine the conduct of the above Review, and to put it into context in the wider body of evidence regarding the effectiveness of water fluoridation. While the overall conclusion that water fluoridation is effective in caries prevention agrees with previous reviews, many important public health questions could not be answered by the Review because of the restrictive criteria used to judge adequacy of study design and risk of bias. The potential benefits of using wider criteria in order to achieve a fuller understanding of the effectiveness of water fluoridation are discussed.

School milk as a vehicle for fluoride in the United Kingdom. An interim report.

OBJECTIVE: To consider the feasibility of using school milk as a vehicle to deliver fluoride to children, suffering from high rates of dental disease, in socially deprived districts. METHOD: The legal aspects of adding fluoride to milk and availability of milk subsidies were updated. The organisational requirements of using school milk as a vehicle for fluoride were investigated and the consultation process established. The uptake of fluoridated milk was monitored and the fluoridated milk was subjected to rigorous quality control. The costs involved in running a scheme were calculated. OUTCOME: Fluoridated milk can now be called milk with added fluoride and to date the product has attracted subsidies from the European Economic Community and from the Welfare Foods Section in the Department of Health. The demonstration scheme in St. Helens, Merseyside, generated interest from neighbouring health authorities leading to the subsequent expansion of the programme. By working with the dairy, recommendations to improve the quality of school milk have been developed. The main organisations involved in running school based milk fluoridation schemes have been encouraged by the low costs involved. CONCLUSION: The UK programme has demonstrated that it is feasible to use school milk as a vehicle to deliver fluoride on a community basis. Attention must be given to improving the quality and particularly the temperature control of school milk.

Some operational aspects of school-milk fluoridation in St. Helens, Merseyside, UK.

St. Helens is a small industrial town situated about 20 km east of Liverpool. It lies in an area of social deprivation and, by UK standards, dental caries experience is high (e.g., dmft at 5 years = 2.8; DMFT at 12 years = 2.7). Water fluoridation is an important part of the government's strategy for improving oral health in such areas; however, in large parts of St. Helens, implementation of water fluoridation is complicated by reason of the multiple sources of water supply. The aims of the St. Helens study are therefore to examine the technical, organizational, and legal aspects of the fluoridation of school milk as an alternative public health approach. In the UK, children attending nursery units (kindergartens) from ages 2-4 years and infant schools from ages 4-7 years are eligible for 189 mL of milk to be consumed each day at school. These two schemes are funded or subsidized by the Departments of Health (UK) or the European Community, respectively. A preliminary review of the possibility of using school milk as a vehicle for fluoride has been published recently (Jones et al., 1992). The current paper will review progress over the past 12 months, including the response of schools, dairies, and other organizational considerations.