You might want to think twice before you cancel that next dentist appointment. Most people consider oral health an important part of overall hygiene, but a study from WalletHub suggests Texas is falling short in keeping those pearly whites, well, pearly.

The study, which looked at 25 factors that affect dental wellness, and therefore overall health, dubbed Texas the tenth-worst state in the U.S. for oral hygiene. The categories studied included dental treatment costs, the number of teens who visited a dentist in the past year and the share of adults who express low life satisfaction due to an oral condition.

What the WalletHub researchers found is that Texas landed at the No. 42 spot in the overall rankings, with an “oral care” rank of 47 and and “dental care & habits” rank of 27.

While unexpected based on the data, Texas actually appeared among the top five states for affordable dental care. The Lone Star State meanwhile locked down the lowest possible spot for number of adults who are unhappy with life because of an oral condition.

Why did Texas land so low on the list? It’s hard to say for sure, but a breakdown of Texas-specific data from WalletHub states that only 59.5 percent of adults in Texas paid a regular visit to a dentist in the last year. Moreover, 61 percent of Texans went to the dentist less often than recommended due to the costs of dental care.

Meanwhile, 15.5 percent of Texans live in areas with shortages of dental health professionals and 14 percent of Texans smoke cigarettes.

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