Our experience has shown that whilst the design of each community milk fluoridation scheme will vary according to local circumstances, certain common issues will apply to all proposals.

The selection of a site will obviously be influenced to a great extent by the oral health status of the children in the community. It is however essential that any exposure to fluoride through the water supplies and other sources is taken into consideration.

Another key issue is the availability of milk. The feasibility and sustainability of a scheme will largely depend on a suitable milk supply being in place. Virtually all types of milk product can be fluoridated; therefore almost any delivery system which provides a regular supply of milk to children could potentially provide a vehicle for fluoride. To date most schemes have utilised an existing milk distribution system such as a school milk scheme or a national nutrition programme. This has simplified the process of implementation and provided a cost-efficient means of targeted fluoride supplementation.

The size that a scheme needs to be to make the production of fluoridated milk viable is another important factor. Our experience would suggest that where fresh milk products are used, typically 4,000 - 5,000 children should be involved. However, this number will vary according to local circumstances and will be largely dictated by the milk production facilities. Schemes that are based on a “long life” (UHT, powdered etc) milk supply can be viable with much smaller numbers; large volumes of milk can be produced, stored and distributed as required over a period of months.

If you are considering exploring the possibility of introducing a community based scheme, you may wish to obtain a copy of the World Health Organization's guidelines, "Development of a Milk Fluoridation Scheme for Prevention of Dental Caries : Preliminary Assessment of Feasibility". This is available either from the Foundation or the WHO.

The document provides an overview of the key stages in the development of a scheme, with particular emphasis on key issues relating to feasibility and sustainability. It includes a questionnaire which will assist you in determining whether local circumstances are suitable for this method of intervention. It is designed to bring together information on:

•	the oral health status of the target population;
•	fluoride status;
•	the availability and suitability of existing milk distribution systems;
•	the organisation and co-ordination of a scheme.

The Foundation has been closely involved with the development of existing schemes and would be pleased to provide assistance to anyone who would like to explore the possibilities of introducing milk fluoridation in their country / region.