Dental health in Kansas has improved since 2003.

But a national organization says the state’s lack of access to dentists in rural areas and Wichita’s resistance to putting fluoride in city water affected the state’s dental health grade.

The state was graded by Oral Health America, a nonprofit group that researches and promotes dental health. Overall, the state scored a ‘B,’ up from a D-plus in 2003.

Kansas benefited from programs started since 2003. Those programs include dental benefits for disabled and elderly people who receive aid from home- and community-based services and an extended-care permit process that allows dental hygienists to provide treatments in underserved communities.

Wichita is the second-largest city in the nation not to fluoridate its water. The only larger city is Honolulu. The group says fluoridated water helps prevent tooth decay.