It is exactly one year since you took the unanimous decision to implement a scheme to fluoridate the public water supply of Southampton, Eastleigh, Totton and surrounding areas. The decision on 26th February 2009 was taken despite widespread opposition from local people with 72% of Public Consultation respondents rejecting the proposal (The Evidence Centre Independent Summary of Responses to the Public Consultation, February 2009).

During the past year, local opposition to the scheme has grown, a 15,300 signature petition has been handed in to Downing Street and EVERY local MP has since written to the Strategic Health Authority to express concern at your continuing determination to impose fluoridation on an unwilling community. Hampshire County Council, Eastleigh Borough Council, Test Valley and New Forest Councils all rejected the proposal and there have been a number of previously supportive Southampton City Councillors who have since expressed concern about the decision.

The most recent NHS dental survey report published in October 2009, showed a decrease in levels of dental decay amongst the city's five-year-olds and an increase in the number of five-year-olds without any tooth decay (NHS Dental Epidemiology Programme for England Oral Health Survey of 5 year old Children 2007/2008). Encouragingly, this means that decay rates in Southampton for five-year-olds are similar to the English average and are below levels recorded in 2001. In order to maintain this improvement, we urge you to ensure that the local NHS places greater emphasis on the implementation of targeted community-based oral health strategies as an alternative to water fluoridation.

An important peer reviewed study published recentlyin the Journal of the American Dental Association confirms previous research showing that infants fed formula milk in areas where the water is fluoridated at 1.0 ppm may receive excess fluoride putting them at risk of fluorosis (Siew, C et al. J Am Dent Assoc 2009; 140: 1228-1236). The authors conclude that "When powdered or liquid concentrate infant formulas are the primary source of nutrition, some infants are likely to exceed the recommended fluoride upper limit if the formula is reconstituted with water containing 1.0 ppm fluoride". Indeed, the American Dental Association recommends that formula milk is reconstituted with fluoride-free water in order to reduce the risk of fluorosis (http://www.ada.org/public/topics/fluoride/infantsformula.asp). We believe that on this evidence alone, it would be irresponsible to proceed with a scheme which may result in some babies exceeding the recommended fluoride upper limit.

Given the financial constraints currently faced by the NHS, we are concerned that precious NHS funds are being used to force through a scheme that the local community does not want. These funds could be better used to develop alternative, more effective oral health schemes. The SHA's decision to continue with water fluoridation and to fight a legal challenge is seen as a waste of Health Service money and we are concerned that this will damage the reputation of the local NHS.

In the light of these facts, we strongly urge you to reconsider your decision.