To properly contextualize this article, it is helpful to define the authors' understanding of the term “internationalization of dental education” (herein referred to as IoDE) and how the authors derived it from another area of education—internationalization of higher education (IoHE).

IoHE refers to an established and defined area of educational research that has been in place for over 25 years and provides frameworks for IoHE (5). The field of IoHE encompasses research and development regarding internationalization of the curriculum; referring to the incorporation of international, intercultural, and global dimensions into higher education in ways that are relevant to graduates' professional practice (6), with the aim to reach all students. Motivations for IoHE include quality improvement, provision of access, competitiveness, growth, and financial profits—resulting in the provision of a professionally relevant education that prepares all students to be interculturally proficient professionals and citizens (7–9).

IoHE includes comprehensive formats to bring global, intercultural, and international dimensions into higher education—from abroad or from within one's home country (9–11). IoHE can occur on many levels within academia, including the institutional, faculty, student, and curriculum levels. Major methods for IoHE can include but are not limited to areas of institutional international partnerships, student inbound and outbound mobility, and internationalization of the curriculum via international faculty, students, global content, and campus internationalization (12–14). A growing area of investigation is IoHE “at home” (9, 14).

It appears that such formats and methods from IoHE are not extensively studied in the health professions (15). Particularly, a link between IoHE and dental education appears to be missing in the global literature.

In the health professions, incorporating elements of social equity, diversity, inclusivity, and cultural competence into healthcare education are increasingly emphasized. In this context, health professions' internationalization efforts often become intertwined and overlap with Public Health and Global Health (GH) (16). While these areas are related and overlap, it is important to identify the differences in their commonly used definitions.

Public Health is regarded as “…the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals…” (17).

GH, as the global counterpart of Public Health, historically evolved from International Health—an area that addresses local, national, and international health concerns on all levels. International health is defined by Merson, Black, and Mills as “the application of the principles of Public Health to problems and challenges that affect low- and middle-income countries (LMICs) and to the complex array of global and local forces that influence them” (18–20).

The definition of GH varies (21). The most commonly accepted definition of GH describes it as: “an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide” (19). Despite this broad definition, the term GH is often associated with educational services or programs coordinated by high-income countries (HICs) of the Global North that are enacted in the LMICs of the Global South [as defined by the World Bank (22)] and/or local programs to address health equity and social justice. GH education is the area of training that focuses on health issues directly or indirectly caused by transnational factors affecting the health of all people (19, 23).

Similarly, in dental education, international efforts are often centered on the term “Global Oral Healthcare” (GOH). GOH is mostly used to refer to international educational efforts to improve oral dentistry and oral healthcare in the context of GH—often, and primarily led by efforts initiated by the Global North to improve oral healthcare in the Global South. Similar to other health professions, GOH is often understood as an extracurricular activity and involves students' international outbound mobility to the Global South, and/or is conveyed via dedicated GH programs (24). Educational competencies taught in GOH education can include teaching intercultural awareness, appreciation of different healthcare systems, and understanding global disease burdens (25, 26).

Dental Public Health or Public Health Dentistry refers to areas of dental care that address the issues of social justice and equity in oral care and is referred to as “the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts.” (27).

IoDE is a term that is related to the above areas. However, while there are overlapping elements (e.g., identification and research of learning objectives), IoDE is not considered an additional content area in dental education. It is an area that incorporates educational formats to address internationalization efforts in dental education. It identifies and investigates the above fields which can be applied and standardized for dental educators to use in practice. Because of this distinction as an educational concept, a separate definition is deemed necessary.

We adapt a definition based on one commonly applied in the field of IoHE (9, 14, 28). Hence, we define IoDE as “the process of purposefully integrating international, intercultural, or global dimensions into dental education in order to enhance its quality and prepare all graduates for professional practice in a globalized world” (9, 14, 28).

Thus, this definition establishes IoDE as a concept of educational processes—with a focus on processes for intentional, systematic, and evidence-based activities designed to ensure that students achieve specific learning outcomes by engaging in high-quality learning experiences.

Motivations for IoHE are determined by constantly changing political, economic, socio-cultural, and academic influences and rationales (3). Understanding motivations for IoDE may yield insight into strengths and weaknesses of programmatic efforts and can aid in successes of future endeavors in an area that is still evolving.

In this scoping review of efforts regarding IoDE formats found in the recent published literature, the authors aim to identify commonalities with elements of IoHE, and recognize gaps that exist in the published literature that may have implications for the dental educator community. This article investigates if and how internationalization efforts in dental education have been executed and published to date, and what perceived major motivations led to these formats. Establishing a baseline of its current status is important to further develop formats and recommendations for IoDE.

This research is important for dental educators not only to identify motivations but also to learn from and apply formats of IoDE that have been published. Identifying parallels with and gaps in relation to IoHE may help dental educators to understand internationalization efforts from an educational format perspective and help to standardize curricula and initiate innovation in IoDE. Since IoDE is a relatively new area, this study may help educators establish educational theory-based international programs. Thus, this study can have future implications for dental education.

Google Scholar, PubMed, Scopus, and Web of Science databases were selected in order to focus on both peer-reviewed health sciences journals and non-health-related scientific journals (Figure 1). Searches included articles published from January 1, 2000, to December 31, 2020. This timeline was selected due to the emphasis on internationalization efforts in other health professions that arose soon after the turn of the 21st century (30); before then, publications on internationalization efforts in the health professions were infrequent. The study's searches were conducted from November, 2020 to February, 2021. Articles not published or indexed before the end date (December 31st, 2020) of each database search were not included in the results.

Because the term “internationalization of dental education” itself is not yet appropriately employed in the literature, the intentionally broad key words “international” and “dental education” were utilized for the initial identification of potentially relevant articles. Titles and abstracts were then manually parsed for keywords “global” and “internationalization” to further identify articles.

Inclusion and exclusion criteria (Figure 1). Included articles were limited to undergraduate dental education. All formats for peer-reviewed articles were included (i.e., research articles, letters, commentaries, and reports). All countries were included. All languages were considered. However, articles not written in English were marked to indicate that content could not be validated and were not included in the final analysis. Nevertheless, abstracts in English were included. Articles comparing multi-national dental curricula, if not pertaining to internationalization efforts in dental education, were not included.

A total of 47 articles were found to be suitable for the review (Figure 1). The initial screening of titles and abstracts was conducted individually, followed by group discussions. The group met several times to discuss discrepancies regarding inclusion or exclusion until consensus was achieved. The senior author made the final decision.

Review of abstracts and full texts was used to sort the articles into themes of educational concepts previously established in IoHE. The authors focused the thematic analysis on formats of comprehensive IoHE that have been previously identified in IoHE (5, 6, 9, 10, 12, 31). Formats focused on major areas outlined by the American Council on Education (5), including institutional international partnerships, student mobility, curriculum, and international efforts at home.

Furthermore, themes for perceived motivations for IoDE, referencing Hanson's model (15), were categorized based on inference of the author's perceived motivation. These motivations included (1) IoDE in order to engage in a competitive market model, (2) a liberal model to foster international understanding and collaborations, and (3) a social transformation model to support health equity and social justice/Global Health. Further details regarding the models of motivation are described in the discussion section.

Once themes were identified, the articles were charted (Table 1).

A large majority (43/47, 91.4%) of articles originated from HICs, notably, with a limited number of involved institutions [including the Harvard School of Dental Medicine (49, 50, 64–67, 76), Tokyo Medical and Dental University (53, 63, 71, 72), and Hong Kong University (35, 42, 43)] producing nearly one-third (30%) of these articles. Furthermore, 7 authors were considered highly-published in this area with more than 1 publication in the final analysis (30, 31, 33–35, 38, 39, 44–52). Only 4/47 (8.5%) articles originated from middle-income countries (36, 47, 69, 70). There were no scholarly articles originating from low-income countries.

A cohort of 5/47 (10.6%) articles were about internationalization in Europe, reflecting collaboration between the US and Europe (35, 38, 46, 73, 77). Of the 13 articles that included international partnerships, 9/13 (69%) described efforts in the LMICs, but all were published by authors and journals originating in HICs (44, 46, 51, 58–60, 75, 76, 78).

Articles included a wide range of topics and were mostly descriptive in nature. The articles focused on international partnerships, student inbound and outbound mobility (including global oral health programs), and 30/47 articles (63.8%) included elements of international curriculum at home activities, including language programs (25, 33, 35, 41–50, 52, 54, 57–59, 61, 62, 64–67, 70, 71, 73, 76, 79, 80). There were 27/47 (57.4%) articles that discussed projects regarding the creation of a global dental curriculum (25, 33, 35, 41–50, 57–59, 61, 62, 64–67, 71, 73, 76, 79, 80).

Many articles (31/47, 66%) included surveys within the study (25, 32, 34, 36, 37, 44–46, 48–56, 58, 61–64, 66, 67, 70–72, 74, 76, 79).

Some articles (14/47, 29%) addressed international partnerships for dental education—often between countries of the Global North (i.e., European partnerships or ADA/European networks) (1, 35, 42, 44–46, 51, 57, 59, 60, 68, 73, 75, 76). Partnerships between the Global North and the LMICs, aimed at providing mission trips for student mobility and/or that addressed areas of GOH, were described in 8/47 (17.0%) articles (44–46, 51, 58, 59, 75, 76).

Student exchanges were addressed in 16/47 (34%) articles—mainly as service missions to LMICs (25, 32, 34, 44–46, 49, 51, 52, 55, 56, 71, 73–76). Only 4/47 (8.5%) articles covered the topic of international inbound students (44, 53, 63, 73).

Internationalization of the curriculum was addressed in 16/47 (34%) articles—via GOH courses in 7/47 (14.9%) articles (25, 48, 49, 64, 67, 69, 76), or language programs in 9/47 (19.1%) articles (41, 43, 52, 54, 61, 62, 70, 71, 79).

Perceived motivations for IoDE were based on Hanson's motivation models (as listed in the methods section). Multiple themes for motivations were coded for in 15/47 (32%) articles (25, 33, 41, 42, 44, 48, 49, 56, 59, 60, 63, 65, 69, 77, 80).

The English language in dentistry as a common international element to give students a competitive edge in the global market was discussed in 9/47 (19.1%) of articles, which were coded as the market model (41, 43, 52, 54, 61, 62, 70, 71, 79). There were 27/47 (57.4%) articles that addressed a global dental curriculum which were coded for this theme as well (25, 33, 35, 41–50, 57–59, 61, 62, 64–67, 71, 73, 76, 79, 80).

The main reasons found for international travel were to provide service in the Global South while obtaining skills in cultural competency and were considered as part of the social transformation model, as described in 22/47 (46.8%) articles (25, 36, 37, 39, 44, 48–53, 58, 63–67, 74–76, 80).

This study bases its analysis on concepts in IoHE to highlight findings regarding the gaps and commonalities between IoDE and IoHE. Particularly, the authors focused on the motivations for IoDE and its formats—based on elements found in comprehensive IoHE.

Comprehensive IoHE is comprised of many factors that have to align for its success (82). Major components include institutional partnerships (including partnering for off-shore campuses) (11), student mobility (inbound and outbound), and international activities at home (9, 13).

IaH programs promote equity by providing equitable opportunities for internationalization to more/all dental students and institutions. IaH appears to be gaining increased interest, particularly due to safety concerns during the global COVID-19 pandemic (85–87). IaH elements can include campus internationalization via inbound international students, or activities at home via global health courses, language courses, (9, 13), etc.

Limited work has been published on IaH in dental education (40, 86). The current work demonstrates that IaH elements depend primarily on workshops (65, 67) and courses (48, 76), and the need for the English language as a concept of IaH (41, 61, 70, 79)—with only one article referencing international peer exposure (42). Virtual international programming can support approaches to IoDE/IaH by leveraging technology for IoDE (88).

Hanson describes three models regarding motivations for internationalization in the health professions (15). Despite overlaps, a look at these motivations individually is important in order to align goals and formats in IoDE.

The market model focuses on competition and positioning of academic institutions in the global marketplace. Often this is achieved via international partnerships (11). Our findings indicate that the market model is predominant in IoDE. The above is in contrast to studies in other health professions, where the social transformation model is predominant (30, 89).

In this review, articles addressing the creation of global dental curricula were perceived by the authors as being part of the market model and were included in the study as an observational finding. In the global literature on IoHE, shared global teaching curricula are typically not part of formats outlined in IoHE. In the health professions, the adaptation of Westernized curricula and training has been a topic for discussion (90, 91), often regarded as an indicator for improved quality of medical education and care (90, 92, 93). For the LMICs, it can be regarded as an advantage for competition. However, its ethical implications and cultural misalignment have often been challenged (90, 91). To date, such discussions are limited in dental education (94, 95). LMICs have followed a Westernization of the dental curricula, as historically, dentistry was less available in the LMICs and development followed the Western lead. Therefore, LMICs did not see the need to restart building curricula. If the LMICs aim for standard curricula to enhance this field in their respective countries, consideration of global educational curricula that are sensitive to cultural and local needs may be necessary in the future.

The topic of a common language for internationalization does play a role in international competition (96). English has been the predominant language since WWII. Therefore, countries and schools aim to provide their graduates with English language skills in order to share scientific knowledge and to remain competitive in the world ranking. Although not explicitly stated as a motivation, articles that described the theoretical benefits of language programs were coded as motivation for the market model—creating a global workforce and/or enhancing competition (41, 55, 61, 62, 70, 71, 79). Of note, two articles found in this category were published in non-English journals with English abstracts (41, 70).

The liberal model focuses on the promotion of international and intercultural understanding—introduced to IoHE in the post-WWII era (97). This model often involves the inbound and outbound exchange of students to support peace and international collaboration. While there are active international student exchanges, very limited reporting and research have been found (71). However, particularly during a time of rising global healthcare nationalism, the ambassadorial role of students for international understanding (“soft diplomacy”) plays an important role in IoHE (97).

The social transformation model emphasizes cross-cultural understanding and healthcare for social justice. For articles that addressed GOH, humanitarian, altruistic goals, and service work experiences for students may be the underlying motivations (25, 44, 69, 74, 76). Such focus mirrors similar activities in other healthcare fields—driven by student and faculty interest in volunteering to support countries in need (16). However, humanitarian work is not available at all institutions and is limited to privileged students and select institutions only. Thus, the way social transformation is currently practiced, often with a one-sided approach, is limited in scope and not socially equitable as it excludes healthcare students from low socioeconomic backgrounds and institutions with limited means.