CHICAGO (AP) — A federal report says three out of four children did not receive all required dental services, such as regular checkups and fluoride treatments, in Medicaid programs in four states. One in four kids failed to see a dentist at all.

The Health and Human Services inspector general’s report was released Monday. It says the reasons include too few dentists accepting Medicaid patients and families uneducated about dental care’s importance.

Investigators looked at Medicaid claims for 2011 and 2012 in California, Indiana, Louisiana and Maryland. The states serve about one-fifth of children with Medicaid.

In 2007, 12-year-old Deamonte Driver of Maryland died from an infection that started in an abscessed tooth, turning national attention to a longstanding economic disparity in children’s oral health. The new report suggests problems still exist.