Milk fluoridation programme for children in rural areas complements water fluoridation in Chile

Chile has been a pioneer in more than one aspect of its approach to fluoridation since the 1950s when it began to implement water fluoridation in some cities. Further implementation into urban and semi-urban areas followed evaluation studies with results which confirmed reduction in dental caries from the intervention. As interest grew in the potential for using milk as a vehicle for fluoride delivery in 1994, a pilot scheme was introduced to the rural community of Codegua, in the country's 6th region, to deliver fluoridated milk in powdered form to young children in more remote rural areas. 

The country has a National Complementary Feeding Programme (PNAC) under which each Chilean child is entitled to receive, at no charge, powdered milk products, from birth until six years of age. This programme was used to provide fluoridated milk products to about 1,000 children through health clinics. After five years a positive evaluation of the project led the authorities to consider introducing milk fluoridation on a wider basis.

A programme operated by the Junta Nacional de Auxilio Escolar y Becas, National School Assistance and Scholarship Board. JUNAEB, an agency supported by the Ministry of Education, which seeks to achieve equality for the country’s school children, was considered as a possible means of providing school children with fluoridated milk. In 2000 a scheme was implemented in the 9th region, and then into more districts at an impressive rate. 

Currently more than 70% of Chileans benefit from fluoridated water, but for technical reasons this intervention remains restricted to urban and semi-urban areas. JUNAEB has proved an excellent vehicle for the delivery of fluoride to children in schools in rural communities, with the milk fluoridation programme complementing the national strategy for water fluoridation. 

To date Chile has been the only country to provide fluoridated powdered milk. Although unusual, this has proved to be an advantage; there are many schools in remote mountainous areas of the country which are almost inaccessible during winter, so that daily deliveries of fresh fluoridated milk would not be possible.  

The work of the Instituto de Nutrición y Tecnología de los Alimentos, University of Chile (INTA), has been key in advancing milk fluoridation in Chile. INTA has provided essential technical support to JUNAEB in programme implementation, monitoring and evaluation, as well as working more generally with JUNAEB to facilitate the expansion of the programme.

Pre the COVID-19 pandemic the milk fluoridation programme in Chile was reaching more than 200,000 children aged 6 – 14 years in 3,600 schools. These are spread across 242 municipalities, in 12 of the country’s 15 regions.