Hawai'i's dental policies for children have earned a failing grade in a report by the Pew Center on States.

Hawai'i was one of nine states that received an "F" grade in the study, which looked at whether and how well each was ensuring dental health and access to care for children.

The report said Hawai'i met only two of eight proven policy solutions, some of which it said can be achieved at relatively little cost but provide a significant return for children and taxpayers.

"Hawaii exceeds the national benchmarks only in its percentage of Medicaid-enrolled children who received dental care in 2007 and its policy allowing hygienists to apply sealants without a prior dentist's exam," the report said.

"Far less favorable is the state's fluoridation rate: At 8.4 percent it is the lowest nationwide."

The report also noted that the state Dental Health Division's Dental Hygiene Branch that was responsible for advancing preventive strategies was dismantled in November because of the state's budget crisis.

The report — "The Cost of Delay: State Dental Policies Fail One in Five Children" — noted that an estimated 17 million U.S. low-income children fail to receive dental care annually.

It said the consequences of these youngsters having a cavity can escalate into a lifetime of challenges, possibly resulting in significant missed school time, serious health problems and difficulty finding a job later in life.

Among the policies the report advocates:

• Having a dental sealant program in place in at least 25 percent of high-risk schools. Hawai'i was one of 11 states with no organized program.

• Providing fluoridated water to at least 75 percent of residents on community systems. The report said that only Hawai'i residents living on military bases receive fluoridated water.

• Paying dentists at least the national average of Medicaid rates for Medicaid-enrolled children. Hawai'i was one of 26 states paying less than the average.

• Having the state Medicaid program reimburse for preventive dental health services. Hawai'i was not among the 35 states doing this.

• Authorizing new types of dental providers to expand access to care. Only one state has done so.

• Submitting basic screen-ing data to a national database. Hawai'i was one of 13 states (plus the District of Columbia) that have never submitted data to the National Oral Health Surveillance System. The report said the tracking data helps states assess problems and policies and compete for grant and foundation funding.

The other states earning a failing grade in the Pew report were Arkansas, Delaware , Florida, New Jersey, Louisiana, Pennsylvania, West Virginia and Wyoming.