The U.S. Centers for Disease Control and Prevention named community water fluoridation “one of the 10 great public health achievements” of the 20th century “because of its contribution to the large decline in cavities in the United States since the 1960s.”

But Hawaii water supplies are not fluoridated. And a recent report from the state Department of Health confirms children in Hawaii have the highest rates of dental decay in the country.

Now, dental experts say fluoridation of water and education are the answers to stopping Hawaii’s perennial prevalence of childhood tooth decay.

The move to require fluoridating water supplies in Hawaii, through legislation, has been tried before — and always failed.

“By preventing cavities, community water fluoridation has been shown to save money for families and for the U.S. health care system,” the CDC says online.

But fluoridation, with education, seems the one overriding view among dental health experts about how to cause an immediate, populationwide improvement.

Recognizing the problem is the first step, said Hilo pediatric dentist Dr. Ruth Ohata, and education “is the key to promoting dental health.”

She said policies that would have an immediate impact include water fluoridation and promotion of healthy eating by eliminating the ability to use EBT cards to buy high-sugar foods and drinks such as candy, cookies, pastries, soda and energy and sports drinks.

Pediatric dental decay in Hawaii has become commonplace.

Dr. Lynn Fujimoto, past-president of the Hawaii Dental Association, said the problem of dental decay among children in Hawaii is “something that we’ve known for a long time.”

“Hawaii always is having one of the highest rates of decay,” she said. Part of the reason, Fujimoto said, is the lack of fluoridation of drinking water.

The decay rates among Hawaii’s young people probably need a collaborative, systemwide approach, Fujimoto said. That means teachers, physicians, school administrators, dental providers, families, public health programs such as Women Infants and Children and Head Start all working in concert.

Families need to be educated about dental health and the consequences of poor dental hygiene, Fujimoto said.

“It can be very costly as far as the children missing school and then the parents have to take time off work,” she added.

“Good habits in childhood stay with you as an adult,” Ohata said. “Prevention is the goal. Good dental health, preventive care and early restorative care equals healthy teeth, beautiful smile, lower cost. Poor dental health, untreated decay equals unappealing smile, pain, tooth loss, higher cost.”

If inroads can be made with young children, Fujimoto said, that will “trickle down” to their dental health in the future.

Public and dental health experts are putting their heads together to try to cut dental decay rates, she said.

Community health centers are an important resource in offering proactive dental care, Fujimoto noted.

“We’re making access an issue so the patients are able to be seen,” she said.

Education is especially important in communities where decay rates are high, Fujimoto said, including teaching children and their parents about dental hygiene.

“Children should start seeing the dentist by age 1,” she said. And that dentist should become the child’s “dental home.”

“People need to recognize the importance of oral health and make it a priority,” Fujimoto said. Along with having a dental home early on, she also advised parents to limit kids’ consumption of sweets and sugary snacks, to make sure kids brush and floss their teeth at least twice each day and to start a conversation with a pediatrician about fluoride drops or chewables.

The CDC recommends parents:

• Ask a pediatrician, nurse, doctor or dentist about fluoride varnish for their child’s teeth as soon as the first tooth appears.

• For kids younger than 6, watch them brush their teeth. Make sure only a pea-sized amount of toothpaste is used and gets spit out (not swallowed).

• Ask your dentist, family doctor or pediatrician if your child needs oral fluoride supplements such as drops, tablets or lozenges.

• Talk to your child’s dentist about dental sealants that protect teeth from decay.