Hawaii’s families have little cause to smile about the state’s poor record of dental health. If it gets much worse, they may be unable to manage more than a toothless grin.

Last year, the Pew Center on the States, a division of the nonprofit Pew Charitable Trusts, issued a report on dental health prevention strategies and how they are implemented across the country. Most of the states, Pew concluded, are lagging behind on the use of dental sealants, which are clear plastic coatings that can avert most cases of tooth decay.

The fact that most states are falling short on this front doesn’t blunt the dishonor of the grade from Pew: Hawaii was one of only five states to garner an "F."

It’s at least encouraging that lawmakers this year are pressing for a first step in a course correction, with outreach to children in public schools.

At a minimum, the Legislature ought to support the state Department of Health in conducting a thorough assessment of Hawaii’s most critical dental health needs. That means funding a single position to 

implement this project, enabled by a $300,000 grant from the Centers for Disease Control. That federal agency is pursuing a scientific, representative sampling of the population here to gauge the oral health problem.

Among the commonly cited causes of poor dental health in this state are the lack of fluoridation of drinking water, a kind of statewide sweet tooth and the general lack of public emphasis on dental care. A perennially controversial notion, fluoridation was banned by the 

Honolulu City Council a decade ago.

But that doesn’t mean Hawaii should simply shrug off the issue. The nonprofit Kokua Kalihi Valley provides a model of what can be done to help the poorest children, taking its dental clinic to schools and providing care the children probably wouldn’t get otherwise. This week at Kalihi Elementary School, students had sealants applied to their cavity-prone molars.

Dental health really matters, to individuals and to society more broadly. Children with untended teeth and gums are more likely to have problems as adults, which leaves them vulnerable to pain and disease and even can limit their job prospects.

And for state budgets, dental disease can be a burden, with Medicaid spending for dental service across the country projected to rise sharply. Nowhere is that more likely to mushroom out of control than in Hawaii, where children were found with the highest risk of tooth decay, according to a national analysis of dental claims. Prospects for low-income children, most of whom don’t even visit a dentist, are sure to be much worse.

Lawmakers can still fulfill a goal this session of providing dental sealants to these children cost-effectively, through school-based programs. Although the legislation introduced for this purpose has stalled, there should be a way to get the initiative started by including funds in bills headed to conference committees.

For the longer-term project, the state’s own dental hygiene branch, or some form of its programs, should be re-established. The agency fell victim to recession-induced budget-cutting five years ago.

Now is the time to consider the consequences of that act. When the hygienists visited schools for screenings and referrals, they found more than a quarter of the children needed acute or urgent dental treatment.

As the state reorders its budgetary priorities for the coming years, dental health should rise several notches higher on the list.