•• Note from FAN: Philadelphia’s water has been fluoridated since September 1954.

Assessments of the well-being of Philadelphia’s children often focus on factors such as immunization levels and lead-paint exposure. While these are critical matters, the No. 1 health issue plaguing children in Philadelphia and across the country today is tooth decay.

Left untreated, dental and periodontal disease can result in problems with eating, speaking, sleeping and learning. In the long term, they can contribute to an increased risk of stroke and heart attack.

Nationwide, pediatric dental disease has approached epidemic proportions. According to a new report, it’s on the rise among 2- to 5-year-olds for the first time in more than 40 years.

In Philadelphia, the findings are equally bleak. Our children are the most likely in the state to suffer from tooth decay. A study conducted between 2005 and 2007 in Northeast Philadelphia found that a third of 2- to 3-year-olds had dental disease, as did more than half of 4- and 5-year-olds and an astounding 80 percent of 7- and 8-year-olds.

Philadelphia’s children are also least likely to access needed treatment and preventive care. A 2003 report found the city had the state’s highest proportion of children who had not visited a dentist in the last year: 23 percent, compared with 12.8 percent statewide.

To a layperson, this information may be shocking. Most people believe that the introduction of fluoride, awareness of the importance of tooth-brushing, and regular dentist visits mean that pediatric tooth decay is a thing of the past. Preventive care and good oral-health habits should render cavities extinct.

But the cavity crisis is worsening. And children from Pennsylvania’s poorest families are suffering in far greater numbers. Eighty percent of dental disease is found in only 20 percent of the state’s children. And while professional care is essential for establishing and maintaining oral health, a quarter of children from low-income families do not see a dentist before age 6.

One of the biggest culprits is the lack of access to adequate dental services. While the number of dental sites and community clinics serving Pennsylvania’s low-income children and families has increased, waiting lists are long, and the clinics are not geographically accessible to everyone.

There are large segments of Philadelphia’s population with no access to dental care and no way to pay for treatment. It is a vicious cycle: Those who need treatment most are often unable to get it, so their condition worsens.

Recently, the city Public Health Department and St. Christopher’s Foundation for Children cohosted a symposium on pediatric dental-health issues. The goal was to raise awareness of the problem, bring together the individuals and organizations needed to address it, and develop creative, workable solutions to get Philadelphia’s children the care they need.

Across the city, there are a number of initiatives and programs working to tackle the problem in innovative ways. The foundation’s Community Dental Program, for example, has served thousands of Philadelphia children between the ages of 3 and 8, bringing dental screening, care and education directly to their neighborhoods. Part of the same program targets kindergartners and third graders in schools in Northeast Philadelphia, promoting healthy oral-hygiene practices.

Other education and awareness programs work citywide to raise awareness, educate and provide care to expectant and new mothers, and work with doctors and nurses who serve children.

To succeed, we need a comprehensive approach of education, prevention, early intervention and treatment. We must engage parents, informing them of the critical importance of dental care and the short- and long-term consequences of forgoing treatment. We also must reach teachers, health practitioners, child-welfare advocates, community members, and others.

We have the tools and treatment to combat Philadelphia’s cavity crisis. We need the will and cooperation to do so.