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.