Bills that would require the counties to add fluoride to their public water systems appear dead for the year, despite a state Department of Health survey released in October that found Hawaii’s children have the most pervasive tooth decay in the nation.

Hawaii is one of just a handful of states that don’t add fluoride to their water supply, which has been shown to reduce tooth decay by 25 percent in children and adults, according to the U.S. Centers for Disease Control and Prevention. The agency considers community water fluoridation as one of the 10 great public health achievements of the 20th century.

Another bill, which would require the state to survey voters during the 2020 general election on whether they would support water fluoridation, also appears dead for the year.

Rep. Matt LoPresti (D, Ewa Villages-Ocean Pointe-Ewa Beach) said he introduced that measure as a way to try to move the conversation about fluoride forward after years of stagnation.

“The point is to get a real pulse of the voting public as to what their views are,” he said. “I think there is such a vocal minority (that opposes fluoridation) that it scares off state legislators from doing the right thing for basic health and safety.”

None of the bills have received a hearing this session, and an internal Thursday deadline for progressing was missed.

The debate over adding fluoride to water in Hawaii dates back decades with opponents claiming that the mineral is harmful to health, despite a lack of scientific evidence supporting that.

Water fluoridation is recommended by the American Dental Association, American Academy of Pediatrics, U.S. Public Health Service and World Health Organization.

Hawaii lawmakers in 2003 actually came close to passing a bill that would have banned water fluoridation statewide. The next year, the Honolulu City Council passed a measure that prohibited fluoride from being added to Oahu’s public water supply. Only military bases in Hawaii fluoridate their water.

Since the contentious debates that occurred over a decade ago, the Legislature appears to have held a hearing only once — in 2008 — on a bill that would require water fluoridation, according to a search through the Legislature’s archives. The measure quickly died.

Sen. Karl Rhoads, who previously served in the House, has introduced bills requiring fluoridation for several years in a row, including this year’s Senate bill, but none of the measures have gotten a single hearing.

“I don’t understand,” he said. “The evidence is overwhelming that it is beneficial and cost-effective.”

While past measures have gone nowhere, some lawmakers were hopeful that the state Health Department’s report on children’s dental health would spur action this year.

The survey of more than 3,000 third-grade students at 67 public elementary schools across the islands found that 71 percent suffered from tooth decay, a figure significantly higher than the national average of 52 percent. About 7 percent of Hawaii’s third-graders are in need of urgent dental care because of pain or infection.

LoPresti said he’s seen the effects of the lack of fluoride in Hawaii’s water supply on his own daughter, who is 7 years old and has already had three root canals despite taking care of her teeth and eating well.

“I think it’s obvious it is a lack of fluoride,” he said.

Sen. Roz Baker (D, South Maui-West Maui), chairwoman of the Senate Commerce, Consumer Protection and Health Committee, didn’t return phone calls seeking comment on why the Senate bill hadn’t moved this year. The measure, Senate Bill 125, had a triple referral, which meant that it needed a joint hearing with her committee along with the Senate Public Safety, Intergovernmental and Military Affairs Committee and the Senate Water and Land Committee.

Rep. Della Au Belatti, chairwoman of the House Health Committee, said she didn’t hear the companion measure, House Bill 264, because she hadn’t seen a “groundswell of support” for it.

“We have dentists coming forward, we have the public health officials within the Department of Health, but I think we need to see more individual advocates come forward and we just haven’t seen that,” she said.

Belatti (D, Makiki-Tantalus-Manoa) said the Legislature is advancing other measures aimed at addressing tooth decay, such as making sure people have access to dental care.

“These other measures are sensible,” she said. “Getting a child to go in and see their dentist is so much more important than just getting fluoride.”