[This story from New York University (NYU) provides a vivid example of how presence-evoking technologies can be more effective than traditional training tools and methods, in this case in the field of dentistry. The flight simulator comparison is a compelling way to emphasize their role and value. Also note (in the last section) the development of more realistic custom controllers to enhance presence. See the original story for five more images. –Matthew]

[Image: NYU dental student Kaitlyn Re (right) practices giving an injection alongside fellow student Dhwani Thakkar (left). Credit: Jonathan King]

Virtual Reality: A ‘Flight Simulator’ for Dental Students

NYU College of Dentistry is developing custom VR technology to help dentists-in-training build their skills, including learning to give injections

By Rachel Harrison
December 3, 2024

It’s no secret that novocaine injections are anxiety-provoking for many dental patients, including the one in four adults with a fear of needles. But what those in the chair may not realize is that they can also be stressful for future dentists who are learning to perform the procedure while putting their patients at ease.

That’s why NYU College of Dentistry is pioneering the use of virtual reality (VR) to give students a realistic way to practice these injections—over and over and over—before they administer local anesthesia in the real-life clinic.

“As dentists, we have to get these skills right—you cannot practice dentistry without anesthetics. That’s why we’re so focused on students being both competent and confident,” says Marci Levine, a clinical associate professor of oral and maxillofacial surgery who has spearheaded the development of VR training at NYU College of Dentistry.

Robert Glickman, professor and chair of the Department of Oral and Maxillofacial Surgery and associate dean for clinical affairs and hospital relations at NYU Dentistry, likens the use of VR in dental education to pilots training using a flight simulator. “Pilots don’t fly a plane until they’ve completed a certain number of simulations,” he says. “Why should dentistry be different?”

Turning to technology

Dental students traditionally learn to administer local anesthesia by injecting each other under the supervision of faculty.

“That is how I learned to give injections as a dental student, as did the majority of the faculty nationwide,” Levine says. “But this approach can present challenges. In the past, students were wrought with anxiety and fear, and their hands would shake. For faculty, it’s a daunting task because you’re using sharp instruments with novice students, and it’s difficult to transfer skills and confidence in a meaningful way. And although rare, complications do happen.”

What’s more, dental school practice injections usually involve real anesthetics. “Students aren’t guinea pigs,” Levine says. “In medicine, sometimes students will practice inserting IVs on each other, but there’s no administration of a pharmaceutical agent.”

Inspired by colleagues in NYU’s Department of Pediatric Dentistry and the Grossman School of Medicine who were creating interactive learning experiences, Levine began redesigning the course she teaches on oral surgery for second-year students. Enlisting the knowledge and skills of Elizabeth McAlpin, NYU IT’s director of educational technology research, she overhauled her large-format lecture course by adding multimedia and interactive components, including videos, role-play exercises, and web-based simulations of the dental office environment.

Students benefited from these new tools, but wanted more direct engagement—including the ability to practice with their hands in a more interactive and immersive way. VR seemed like the best tool for providing that kind of experience. Cristian Opazo, director of educational technology at NYU Dentistry, assessed the current market for VR simulation technology and saw an opportunity for the College to create its own customized virtual training program from scratch.

Over the past few years, Levine, Opazo, and their team have created a simulated dental office modeled after a second-floor clinic at NYU Dentistry. Inside is a mock patient in a dental chair who offers a detailed view of the anatomy of the face and mouth. Using a VR headset and hand controllers, students enter the simulation to set up their equipment, interact with the virtual patient to prepare them for the procedure, and give an injection. Along the way, the system provides real-time feedback to guide students through repeated practice.

What it’s like for dental students

NYU dental students are introduced to the clinical uses for anesthesia during the spring of their second year of school. After learning about anesthesia in the classroom, they head to the College’s VR lab for a one-on-one instructional session on administering injections in the simulated environment. Then, during their third year of dental school, students are required to check out one of 60 VR headsets, taking it home to practice in the days before they are scheduled to administer injections to patients.

“It helps to not only reaffirm, refine, and refresh, but it also mentally gives students a boost. With the VR available on demand, students can take it home, work on it, and do it again and again with feedback,” says Levine.

For Angela Jang, now a third-year dental student, last spring was the first time she had ever put on a VR headset. To prepare for seeing patients in the oral surgery clinic this October, she checked one out to practice at home, visualizing the procedure—the room, the dental chair, and the anatomy of the virtual patient’s head and mouth—before greeting her first patient in the clinic.

“Having that mental map in your mind that you see in the VR really helps—you can apply it clinically,” Jang says.

Ramtin Dastgir, by contrast, already knew a thing or two about VR before this experience. He has his own headset for gaming and studied the use of VR in an oral surgery research fellowship before coming to NYU.

Dastgir, an advanced standing dental student preparing to practice in the US, completed dental school in 2022 in his home country of Iran. Like most dentists-in-training, he learned to administer oral anesthesia by injecting other students—and was also on the receiving end of practice pokes. “When the other student is giving you an injection, it’s pretty stressful,”  he says. “Everyone is hovering around you, which could make people nervous.”

Even though he had already been a practicing dentist before coming to NYU, Dastgir appreciated the less nerve-wracking opportunity to brush up on his skills using VR before seeing patients again after his two-year hiatus for research.

What’s next: adding a special “touch”

Levine and her team are continuing to make and test design changes to the VR system. These include, for instance, creating a simulation for injecting children’s smaller mouths, and options for students who are left-handed. They also hope to expand beyond anesthesia to build simulations for irreversible dental procedures such as extractions. At the same time, they’re constantly evaluating the educational effectiveness of this use of VR, with McAlpin spearheading research to understand the technology’s impact on student satisfaction, confidence, and the clinical experience.

Based on student feedback, the team is also working toward a next-generation controller that provides a more realistic tactile experience for students. To develop it, Levine has enlisted the expertise of Mohamad Eid, an associate professor of electrical and computer engineering at NYU Abu Dhabi and an expert in the field of haptics, or using technology to create a sense of touch. The collaboration between Eid and Levine was fostered by a 19 Washington Square North Faculty Fellowship that aims to build connections between NYU faculty in Abu Dhabi and New York.

“We heard from students that the current controllers don’t have the weight, depth, and dimension of a real syringe,” Levine explains. “Mohamad and his team created a 3D-printed prototype syringe which has specific design elements that allow for force feedback, giving students a much more realistic feel.”

As the team continues to improve the technology, Opazo is in conversation with other dental schools eager to incorporate VR in their own education programs, with five schools expressing interest in licensing NYU’s custom system.

Beyond dental schools, Levine can envision many other applications of VR for health professions that require hands-on training, including nursing and veterinary schools.

“I would love to see VR become part of mainstream health care education,” she says.

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The project has been supported by the NYU Office of the Provost, NYU IT, NYU Abu Dhabi, NYU Center for Faculty Engagement, NYU College of Dentistry, and NYU Technology Opportunities and Ventures, as well as Septodont USA.