Exploring Trends and Challenges in Global Health Dental Education: Scoping Review

According to the World Health Organization (WHO): “Oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions, such as eating, breathing and speaking, and encompasses psychosocial dimensions, such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment.” It changes throughout the lifespan, is fundamental to overall health, and promotes engagement in society and personal fulfillment [1]. The global health concept does not require that a health crisis transcend national borders. It addresses health challenges that transcend national boundaries, influenced by transnational factors such as climate change and global efforts toward disease eradication. In addition to epidemic diseases, global health addresses issues such as tobacco control, nutrition, obesity, injury prevention, migrant health, and health worker mobility, recognizing that global refers to the breadth of problems beyond geographic location [2]. Global health in dentistry is defined as the pursuit of optimal oral health for all people and the elimination of global health inequities. This is accomplished through health promotion, disease prevention, and the implementation of effective oral care strategies that target shared determinants and solutions [3].

Global oral health education encompasses the preparation and training of health professionals with the skills and knowledge needed to address oral health challenges in a global context. This educational approach aims to empower health professionals to understand the importance of recognizing oral health as an integral part of overall health [4]. In dentistry, a predominantly treatment-oriented, interventional, technical, and increasingly specialized and high-tech approach to care persists. However, this approach has failed to effectively address the global burden of oral disease. Comprehensive reform of dental care systems is a necessity [5]. Significant inequalities in the severity and prevalence of oral diseases between and within countries highlight the need for a new paradigm focused on the social determinants of health, integrating oral disease prevention into broader health promotion strategies [6]. In the past 20 years, oral health has faced challenges such as growing inequalities in access to services, dentist-centered rather than preventive care, limited essential service coverage for vulnerable populations, and social, commercial, and political barriers to effective policy implementation [7]. The WHO, through the Draft Global Oral Health Action Plan 2023–2030, aims to achieve universal health coverage for oral health for all individuals and communities. The plan seeks to guide member states in developing ambitious national responses to promote oral health, reduce oral diseases and inequalities, and strengthen efforts to comprehensively address these conditions [1].

Therefore, it is essential to understand how global oral health education can help mitigate the aforementioned problems and how this approach is currently being implemented. This understanding is critical for the continuous improvement of undergraduate dental curricula and their impact on the international stage [5]. It is important to review the dental curriculum to adapt to changes in current and future disease demographics, advances in science and technology, transformations in societal culture, the information revolution, increased patient involvement, and the increasing integration of science and research [8]. This scoping review aims to map scientific articles that address global oral health education, its practical reality, and curricular inclusion in the undergraduate programs in dentistry.

The study is a scoping review, which aims to map research areas rigorously and transparently within a limited time frame. It seeks to identify gaps in the evidence base and facilitate the effective dissemination of findings to policymakers, professionals, and consumers [9]. The Joanna Briggs Institute (JBI) guided the approach taken and aimed to map the literature [10]. As suggested by the JBI criteria, the search was carried out by blind and independent reviewers in four databases. The inclusion factors considered were gray literature studies and articles published in Portuguese, English, and Spanish. The article was registered in the Open Science Framework (OSF) under doi identification: (OSF identification). In this study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) extension checklist was used [11].

The review seeks to map the literature on global oral health education, its practical reality, and curricular inclusion in undergraduate dentistry courses. Thus, this study aimed to contribute to understanding the evolution of dental education and the dynamics of studies in health institutions of global health context. Two questions guided the analysis proposed in this review:

• (a)

  What is the published literature scope focusing on global oral health education?

• (b)

  How has the study of global oral health education contributed to professional training in the dental field?

The question was structured based on the PCC mnemonic (population – concept – context) according to the methodology [10] that guided the search and refinement of the inclusion and exclusion criteria used for this review. These criteria are presented in Table 1. Mnemonic used to identify the research question was according to JBI, 2024.

The search was conducted in the PubMed, ScienceDirect, Biblioteca Virtual em Saúde (BVS), and Scientific Electronic Library Online (SciELO) databases. The descriptors used, according to the Health Sciences Descriptors/Medical Subject Headings (DeCS/MeSH) platform, were “global health” and “education, dental,” and the Boolean operator AND. The search was conducted between May and June 2024. The inclusion criteria were articles and gray literature in Portuguese, English, and Spanish, in a global context, with maximum scope, without time restrictions. The exclusion factors were studies that were not within the scope of the search and duplicate articles. In total, 208 articles were found in the databases: 98 from PubMed; 96 from BVS, 04 from SciELO, 08 from ScienceDirect, and 02 from outside the databases.

Inclusion and exclusion criteria were used to select the chosen studies to direct the focus of the topic under discussion, which are explained in Table 2. The search conducted in the databases resulted in 208 articles found and, using the Rayyan platform (Qatar Computing Research Institute), 89 duplicates were excluded, leaving 119 articles. After reading the titles, 74 articles did not fit the research scope, leaving 45 articles for analysis of the abstracts. Ten articles were discarded after reading the abstracts and 35 remained for full reading. Four of these were excluded due to the impossibility of data extraction and five because they were not directly related to the scope of the research, resulting in 26 articles. The data were analyzed and extracted by consensus among the blind and independent reviewers in the selection. Figure 1 presents a flowchart of the method used, organized according to the PRISMA Statement standard [11].

The selected studies addressed a variety of objectives that reflect the complex intersections between dental education and global health. Some articles have focused on adapting dental curricula to new global trends and challenges in oral health [12‒20], while others have explored the integration of oral health into global health policies and oral disease prevention [6, 14, 21‒24]. Furthermore, there has been significant emphasis on the need to increase the literacy and engagement of dental students and professionals with global issues, promoting global competencies and interprofessional collaboration, and offering opportunities for international volunteering, partnerships, and immersion programs [4, 13, 15, 25‒28]. Studies have also highlighted the importance of preparing future dentists to address oral health inequalities and fostering interprofessional and international collaboration to address these challenges [6, 14, 22, 29‒34]. Taken together, these objectives underscore the need for an educational approach that not only educates to produce competent professionals but also global citizens who are aware of the social and cultural responsibilities in dental practice [35].

In this scoping review, most studies used narrative review methodologies (44%). Quantitative studies accounted for 20%, evidencing the application of statistical analyses. Qualitative studies accounted for 12%, showing the need for information on experiences and perceptions. Editorials accounted for 8%, sharing perspectives, experiences, and recommendations on global oral health education. Qualitative-quantitative methodologies, combining quantitative and qualitative approaches, constituted 8% of the studies. Integrative reviews represented 4%, seeking to critically evaluate previous research. Finally, scoping reviews completed the sample with 4%, contributing theoretical reflections and comprehensive summaries of the field investigated.

The diversity of nationalities of the authors is an important aspect of global health education in Dentistry, reflecting the variety of perspectives and approaches. In this scoping review, 26 studies were analyzed. Authors from the USA contributed 58% of the studies. Canada, Australia, the United Kingdom, Tanzania, and Switzerland contributed 4% each. Studies by authors from multiple countries were identified, including USA, United Kingdom, Belarus, Ireland, Finland, South Africa, Trinidad and Tobago, Netherlands, Romania, Malaysia, Greece, Sweden, Thailand, Egypt, Slovenia, Bulgaria, France, Croatia, Australia, Colombia, Nigeria, India, China, Turkey, Japan, South Korea, Canada, Kenya, and Peru, representing 22%. This mix of nationalities enriches the literature by incorporating different experiences and approaches, which is essential for a comprehensive and inclusive understanding of global health. The descriptive summary of the studies has been presented in Table 3.

After a detailed analysis of the studies that comprised the final sample, it was possible to identify and organize the results into categories, based on recurring or convergent outcomes. Pedagogically, the findings were classified into three main categories: trends and challenges in global dental education, oral health inequalities and the need for global approaches, and integrating global health into the dental curriculum, which would be discussed in the Discussion section.

Global dental education is evolving to address new challenges, emphasizing technology, international collaboration, and global health principles. Shifting from treatment-focused models to preventive, evidence-based approaches, education now prioritizes interdisciplinary collaboration and reducing disparities in care. Integrating global health competencies into curricula is essential to prepare future professionals to tackle oral health challenges in diverse and interconnected contexts.

Trends in global dental education are strongly influenced by the increasing emphasis on technology, international collaboration, and global partnerships. Technology has become an indispensable tool, providing platforms for sharing resources, expertise, and information among institutions around the world. These collaborations allow for the development of more robust and diverse educational programs that encompass a broader range of knowledge and skills [29, 30]. The exploration of different formats of internationalization, such as institutional partnerships, student mobility, and curriculum internationalization, can be motivated by the search for improvements in quality, increased competitiveness, and financial benefits, promoting significant changes in dental education [20].

Successful initiatives have demonstrated the positive influence of partnerships, indicating that leadership programs and international volunteer opportunities can significantly improve dental education by promoting students’ professional and cultural development [13, 31]. Integrating global oral health improves students’ knowledge, attitudes, and cultural competence, better preparing them to face oral health challenges in diverse contexts [19, 27, 35].

In addition, preparing future professionals to work in multidisciplinary teams is essential [14, 25]. The transition from a treatment-centered to a preventive and evidence-based model of dentistry is essential for promoting oral health and integrating it with primary health care [6, 23, 24]. This requires training professionals who are able to collaborate effectively with physicians, nurses, nutritionists, social workers [4], and other health professionals. The internationalization of dental education through institutional partnerships and student mobility is essential to prepare students for the global challenges of oral health [20, 29, 30].

Significant disparities have been found in the prevalence of oral diseases between regions of the world, with a reduction in caries in developed economies and an increase in developing economies, highlighting the need for public policies that promote preventive behaviors, ensure access to high-quality services, and update information with regular surveys [12, 21]. The World Health Organization (WHO) emphasizes the integration of oral health into the prevention of chronic diseases and the promotion of general health, highlighting the need for public policies that promote broad preventive behaviors, ensure access to high-quality services, and encourage ongoing research [22, 23].

International collaboration in dental research and education is important to strengthen the capacity to respond to oral health inequalities, especially in low- and middle-income countries [22, 27, 34]. Modern dentistry relies on a preventive and evidence-based approach, which includes the promotion of oral health as an integral part of general health, the adoption of new technologies and prevention methods in clinical practice, the use of interprofessional approaches to the prevention and management of oral diseases, and investment in research training programs in low- and middle-income countries, to mitigate inequalities and promote significant advances in the field [23, 24, 28, 34].

To approach oral health inequalities, specific global health competencies need to be developed among dental professionals. Global health competency-based education, which includes critical evaluation of volunteer programs and integration of global health principles and practices into existing curricula, is essential. This should be accompanied by mentoring and public health knowledge so that students engage responsibly in volunteer activities, following international ethical guidelines [15].

Furthermore, the implementation of a competency framework for global oral health emphasizes collaboration among diverse groups and professions, necessitating an interprofessional approach to the prevention and management of oral diseases, and integrating oral care into primary health care [4, 24]. Dental education should include didactic, experiential, and research learning, with a focus on sustainable approaches and documentation, evaluation, and dissemination of the results of global oral health programs for the benefit of the dental communities and global health [18].

International volunteering, when integrated with systematic and culturally sensitive educational modules and complemented by mentoring and public health expertise, can be a powerful tool for preparing future dental professionals to reduce global oral health inequities [13, 16]. The immersive experience has also been shown to be effective in increasing participants’ cultural and social understanding of oral health and the social determinants of health, highlighting the positive influence of immersion on their education and future practice by promoting a preventive and interprofessional approach to health care [28]. These strategies are crucial to preparing 21st-century health professionals to address global oral health challenges effectively and collaboratively [4].

An effective dental curriculum should consider demographic and oral health trends, emphasizing social responsibility, professional ethics, and a multidisciplinary approach [12]. Furthermore, the integration of global health competencies into dental curricula is essential to prepare future professionals to address inequalities, emphasizing social responsibility, professional ethics, and a multidisciplinary approach [12, 15, 35]. Implementing competency- and evidence-based curricula, including practical placements in vulnerable communities, can increase students’ understanding of global oral health needs, promote interprofessional collaboration, and integrate oral care into primary health care [4, 17, 18, 24].

In order to integrate global health into dental curricula, it is important to consider the perspective of students and create a positive academic environment that promotes their well-being and prepares them for their future careers [35]. Future professionals’ sensitivity to global health issues should be emphasized, along with the integration of clinically relevant courses and faculty training in interprofessional education [26, 35]. The combination of didactic and experiential learning has been shown to significantly improve student learning about global oral health [18, 32].

Modules that enhanced cultural competence and ethical knowledge in global health demonstrated the potential to improve students’ perspectives in this field [27]. Immersive experiences were effective in increasing participants’ cultural and social understanding, highlighting the importance of preventive oral health practices and appreciation of cultural diversity [28]. A curricular reformulation that combines didactic and experiential methods and promotes immersion in different cultures is important to increase students’ knowledge in a meaningful way, generating a positive and lasting impact on their lives [16, 32].

This scoping review highlighted the increasing integration of global oral health education into dental curricula, reflecting a response to emerging needs in a globalized world. The literature reviewed underscored the importance of preparing dental professionals to face oral health challenges holistically and interprofessional, promoting an approach that aims at technical competence and raising awareness of global health inequalities.

Despite significant advances, gaps persist in the practical implementation of these approaches in undergraduate dental curricula, especially in low- and middle-income countries. The methodological diversity of the studies analyzed reflected the complexity of the field, requiring greater agreement on educational practices and the creation of programs that encourage international collaboration and the development of global competencies.

Thus, global oral health education emerges as a determining component for the training of dentists who can effectively contribute to improving oral health in diverse and challenging contexts, strengthening public health, and reducing health inequalities worldwide. This scoping review contributed to the understanding of current trends and challenges, providing a basis for future research and curricular development in the field of dentistry.

Ethical approval and patient consent are not required since this study was a scoping review.

The authors have no conflicts of interest to declare.

The work is supported by the Fundação Araucária/SETI, through a scholarship granted to Victor Augusto Danelle Grant No. 11/2023. The funder had no role in the design, data collection, data analysis, and reporting of this study.

All authors had full access to the study data and assumed responsibility for the integrity of the data and the accuracy of the analysis. Beatriz Helena Wolpe was responsible for the study design, data acquisition, analysis, interpretation, drafting of the manuscript, and provided final approval of the version to be published. Isabela Rodacoski and Victor Augusto Danelle contributed to the study design, data acquisition, analysis, interpretation, and manuscript drafting. Maria Rosa Machado Prado and William Augusto Gomes de Oliveira Bellani contributed to the study design, critically revised the manuscript, and approved the final version for publication.

All data produced or analyzed in this study are presented within the article. Additional inquiries can be addressed to the corresponding author.