A new survey has documented what most dentists here already suspect — that Hawaii children have the highest prevalence of tooth decay in the nation.

The results of a first-of-its-kind survey of more than 3,000 third-grade students at 67 Hawaii public elementary schools on six islands were released Monday by the state Department of Health.

The survey, conducted in the 2014-2015 school year as part of a national study, found just over 7 out of 10 Hawaii third-graders — or 71 percent — are affected by tooth decay, a figure significantly higher than the national average of 52 percent.

“We learned that too many of Hawaii’s children are affected by tooth decay,” said Danette Wong Tomiyasu, deputy director of the Health Resources Administration in the state Health Department.

Officials said the findings point to a need for increased dental care, more screening and referral services, and culturally appropriate prevention programs.

“We’ve known for a long time that we’ve had poor oral health, particularly for the children in the state,” Dr. Virginia Pressler, state health director, said at a news conference in Honolulu on Monday. “We know we can do better. And the way we’re going to do better is through collaboration (with) our community partners.”

Working with Hawaii Dental Service and others, the state will begin expanding community-based preventive programs, incorporating oral health into early childhood school and public health programs, and experimenting with teledentistry as a way of increasing access to dental care, she said.

One key reason Hawaii suffers from poor oral health, health officials said, is because fluoride generally is not added to Hawaii’s water as it is on the mainland.

However, officials said they don’t anticipate lobbying for fluoridation after having had so many proposals defeated over the years.

The latest survey, compiled in a report titled “Hawaii Smiles 2015,” was funded by the U.S. Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services, with additional local funding from the HDS and the Kaiser foundations.

The survey found that almost 1 in 4 third-graders has untreated tooth decay.

“This indicates they’re not receiving the dental care they need,” Tomiyasu said.

The survey also found that about 7 percent of Hawaii’s schoolchildren have an urgent need for dental care due to pain or infection. The national average is less than 1 percent.

If the 7 percent were applied to all children in kindergarten through sixth grade, more than 6,600 elementary students experience pain or an oral infection due to dental disease on any given day, the report said.

Significant disparities in oral health were found by income level, according to the survey. About 31 percent of children from low-income families, defined as those who are eligible for the National School Lunch Program, have untreated tooth decay, compared to 13 percent of those who are not eligible.

The need for urgent dental care is about six times higher in Hawaii’s low-income children compared to their higher-income peers.

According to the survey, Micronesian and other Pacific islanders, including those from Guam, Samoa, Tonga and elsewhere, have the highest prevalence of untreated decay. About 56 percent of Micronesian and 41 percent of other Pacific islander children have untreated decay — four times higher than Caucasian (13 percent) and Japanese (11 percent) children.

Ethnic disparities were also seen for children needing urgent dental care: 30 percent of Micronesian and 23 percent of other Pacific island children have dental pain and infection compared to only 3 percent of Caucasian and 2 percent of Japanese children.

Third-graders on Kauai, Maui and Hawaii island are more likely to experience tooth decay than children living on Oahu, the survey found, while more than 60 percent across the state do not have protective dental sealants, which officials say is a safe and easy way to prevent tooth decay in molar teeth.

While the survey results are not surprising, Pressler said, the findings will help officials focus their efforts to improve oral health among Hawaii’s youngest population, especially those from low-income families, the Pacific islands and rural areas on the neighbor islands.

Hawaii, along with Oregon and Colorado, will start a pilot teledentistry project to demonstrate how access to dental care can be brought to rural and low-income areas.

The project, based on a recently completed six-year Virtual Dental Home pilot program in California, involves a dentist telecommunicating with a dental assistant and dental hygienist in the field.

“The findings show that this is a very safe, effective and cost-efficient way of providing care to the most needy population,” said Dr. Andrew Tseu, chief of the state Hospital and Community Dental Services Branch.

As for fluoride, only Hawaii’s military bases have fluoridated water, comprising about 10 percent of those connected to a public water system in the state. On the mainland, 75 percent of the population connected to a public water system receive fluoridated water.

Proposals to add fluoride to Hawaii’s public water systems have been defeated multiple times in recent decades by many with concerns about its health effects and impact on water quality.

But Dr. Steve Wilhite, president of the Hawaii Dental Association, said fluoride is safe, and his organization is still hoping it will show up in Hawaii’s future. When water is fluoridated, he said, a 50 percent reduction in decay is seen in less than 10 years.

“The science is behind it,” Wilhite said.

According to the American Dental Association, water fluoridation is so effective at preventing tooth decay that the CDC named it one of 10 great public health achievements of the 20th century.