The USA’s supposedly winning smile earned a lackluster C-minus on the nation’s first Oral Health Report Card, to be released today.

The report card was issued by the non-profit advocacy group Oral Health America. It offers a state-by-state glimpse at the causes of a “silent epidemic” of oral diseases described by Surgeon General David Satcher in a report, “Oral Health in America,” out earlier this year.

“The report card findings support what we found nationally in the surgeon general’s report,” says Satcher, who emphasizes that he was not involved in the preparation of the report card, which was reviewed by the federal Centers for Disease Control and Prevention.

Three broad categories got special attention: prevention; access to dental care; and health status, which is an overall snapshot of oral health based on factors such as tooth loss, oral cancer and oral health in children.

The report found extreme variation among the states on a number of measures, including the fluoridation of public drinking water, an effective means of preventing tooth decay and oral cancer.

The USA landed its lowest grade in access to care. Roughly 108 million people, including 85% of the elderly, lack dental insurance. All but 10 states and the District of Columbia earned F’s for failing to provide dental insurance to people over 65.

While several states, notably Hawaii, Illinois, Indiana, Iowa, New Mexico, North Carolina and New York, earned top marks in specific categories, not one earned an overall A in all categories. North Dakota with a B-minus fared best overall.

The nation’s low grades can be lifted with substantial political will and minimal funding, says Robert Klause, director of Oral Health America. “All of this is doable. That’s what’s so frustrating about it. It won’t break the bank, either.”

Among the findings:

* No state earned an A for preventive services; South Carolina and Wyoming got F’s.

* Thirteen states got A’s for fluoridating water supplies for most of their residents. Eleven, including California, received F’s for failing to bring this preventive measure to even 10% of residents.

* Twenty-seven states do a poor job of collecting data on oral health in children, gathering so little information that they could not be graded. Louisiana, North Dakota and Washington earned A’s.

“We found that there are serious problems in terms of access to oral health care,” Satcher says. There are 100 million people in this country without access to fluoridated water and over 100 million people in this country without dental health insurance. For every child who is uninsured for medical care, there are two to three children who are uninsured for dental care. Only one in five children on Medicaid see a dentist in any given year.

“They certainly aren’t going to have sealants (plastic coatings that protect fragile teeth) if they don’t see a dentist.”