59,000-year-old tooth offers a rare glimpse into how Neanderthals handled a medical problem

By Ashley Strickland, CNN

(CNN) — An unusual tooth found in a cave offers a rare glimpse into a surprising procedure prehistoric humans might have performed to fix a cavity 59,000 years ago.

Researchers uncovered the lower molar of an adult Neanderthal in Chagryskaya Cave in what’s now Russia, located in southwestern Siberia’s Altai Mountains, a site where populations of these early humans lived between about 49,000 and 70,000 years ago.

Dubbed Chagyrskaya 64, the tooth stood out among dozens of others found in the cave because its crown featured a deep, irregular hole that extended all the way into the pulp chamber, or the inner cavity containing nerves and blood vessels. The chasm looked like a painful cavity that took up most of the tooth’s chewing surface.

Scientists were further intrigued when they spied scratches on the tooth around the hole, suggesting manipulation using a tool of some sort. Fine-pointed stone tools also unearthed in the cave provided possible clues to what made the marks.

Multiple scans of the Neanderthal tooth, as well as experiments using tools on modern human teeth, suggest that someone had essentially drilled out the cavity. This evidence points to the earliest known instance of dental cavity intervention in human evolutionary history, according to a study published Wednesday in the journal PLOS One.

Such behavior indicates that Neanderthals could identify an infection and craft and select the right tools and techniques to alleviate the pain it caused — as well as endure a painful procedure. Wear patterns on the tooth also show that the individual was able to keep using their tooth after the procedure.

“What amazed me was how intuitively the person who owned this tooth understood exactly where the pain was coming from and realized that its source could be removed,” said lead study author Alisa Zubova, senior researcher at the Peter the Great Museum of Anthropology and Ethnography at the Russian Academy of Sciences in St. Petersburg. “We have never encountered anything like this before — neither among Neanderthals nor among modern humans from much later periods.”

The findings add to a growing body of evidence that Neanderthals — our closest extinct human relatives — were cognitively and psychologically more similar to modern humans than previously thought, rather than the simple-minded, brutish cavemen of earlier stereotypes.

“This tells us that the emotional and conscious parts of the Neanderthal mind operated independently, just as they do in modern humans,” Zubova said.

Evidence of medical intervention

Nonhuman primates like chimpanzees have demonstrated the ability to treat themselves or others in their community with medicinal plants — a behavior that experts have said is instinctual.

Neanderthals appear to have done the same, aiding members of their species who experienced injuries or hearing loss by sharing food or protecting them as a form of social care, said study coauthor Ksenia Kolobova, head of the Laboratory of Digital Archaeology at the Institute of Archaeology and Ethnography of the Siberian Branch of the Russian Academy of Sciences in Novosibirsk, Russia.

However, researchers have long tried to distinguish whether early humans such as Neanderthals were capable of taking that care a step further by implementing deliberate medical strategies.

When the researchers saw the cavity-afflicted tooth, they wondered whether the potential evidence for the tooth’s manipulation could showcase an example of targeted medical intervention.

Scratches on Neanderthal teeth had been seen before, suggesting they used toothpicks to remove food or even chewed on medicinal plants. But cavities were a rare issue for Neanderthals, based on numerous studies of their teeth. Neanderthals had a much richer oral microbiome than modern humans, as well as a low-carbohydrate diet, both of which resulted in fewer cavity-causing bacteria, previous research has shown.

Researchers used multiple scanning techniques to analyze every aspect of the tooth, including wear patterns. The combined observations identified that the Neanderthal definitely had a cavity while they were alive, although a cause for the cavity was not determined.

The scans also revealed microtraces of the drilling and rotating motions used by a small, pointed tool that successfully removed the cavity. Exposing the dental pulp and cleaning out the cavity’s contents also would have deadened the nerves and blood vessels there, leading to pain relief, Zubova said.

While fine-pointed perforators made from local jasper found in the cave appeared to match the profile, there was only one way to find out: an experiment to carry out some prehistoric dentistry.

Experimenting with a Neanderthal technique

The researchers used three modern human molars, including one with a cavity on its crown enamel and two with significant enamel loss like the Neanderthal tooth, for their experiment.

Study coauthor Lydia Zotkina, an expert in stone tool production and usage, carried out the experiment. She is a researcher at Institute of Archaeology and Ethnography of the Siberian Branch of the Russian Academy of Sciences. Previous research suggested that only stone, rather than bone, wood or any other material available to Neanderthals, would be strong enough to modify the structure of a tooth, according to the study.

Zotkina used a tool made from jasper to create depressions in the teeth through drilling or rotating motions, eventually reaching the pulp chamber. To replicate the conditions of being within a mouth, a small amount of water was applied to each tooth. She was successfully able to reproduce what the team observed in the Neanderthal tooth and remove the majority of the dental tissue for each tooth with manual drilling in less than an hour.

There were limitations to the experiment, notably the differences between the teeth of Neanderthals and modern humans. Neanderthals have relatively thinner enamel that spreads over a larger area, Zotkina said.
And the Neanderthal molar had an enlarged pulp chamber.

The team also acknowledged that the realities of Neanderthal dentistry would have been more challenging.

“When Lydia experimentally replicated the procedure on modern human teeth, she needed concentration and fine motor control,” Kolobova said. “In real life, the tooth was in the mouth, and inflammation and swelling would have created additional difficulties, clearly making the situation even more complex. However, a Neanderthal 59,000 years ago achieved essentially the same result with a stone tool and without anesthesia.”

Every time Zotkina goes to the dentist now, she said she thinks about the Neanderthal patient who withstood a painful cavity and equally excruciating treatment.

“What struck me, and continues to strike me, is what an incredibly strong-willed person this Neanderthal must have been,” she said. “He must have surely understood that although the pain of the procedure was greater than the pain of the inflammation, it was only temporary and had to be endured.”

Pinpointing the evolution of healthcare

The researchers have a theory for how the dentistry scenario may have played out.

Chagyrskaya Cave would have served as a residential camp for Neanderthals. The individual with the cavity would have exhibited signs of being in immense pain, possibly unable to chew properly, which could have led to malnutrition or a deeper infection of the jawbone, Kolobova said.

Another member of the camp, perhaps one who produced the tools found in the cave, drilled into the tooth.

“The mouth is a difficult space to work in; you need good manual dexterity, patience, and a helper who can hold the head still,” Kolobova said. “I think this happened within a close social bond, possibly between family members.”

Alternatively, the Neanderthal may have self-treated.

“This discovery represents a genuine milestone for both anthropology and evolutionary dentistry, because it documents the crucial transition from instinctive self‑medication, which we also observe in non‑human primates, to a truly intentional and deliberate medical strategy,” wrote Dr.
Gregorio Oxilia, associate professor in human anatomy in the department of medicine and surgery at LUM University Giuseppe Degennaro in Italy, in an email.

Oxilia was not involved in this research, but he has previously studied scraping techniques that were used to treat carious lesions in a Homo sapiens individual about 14,000 years ago.

The drilling method in the new study appears much more technically sophisticated and was carried out with precise dexterity, he said.

The findings also point to a cognitive convergence between Neanderthals and modern humans, Oxilia added.

“It suggests that the roots of invasive medicine and surgery do not belong exclusively to Homo sapiens, but are part of a broader legacy shared with our closest relatives,” Oxilia said. “In this sense, Chagyrskaya 64 pushes back by tens of thousands of years the earliest evidence of interventional dental care, placing it within a context of clinical awareness and technological ingenuity that fundamentally reshapes our understanding of the evolution of human healthcare.”

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