Researchers have identified what they say is the world’s oldest evidence of invasive dental treatment on a 59,000 to 60,000-year-old Neanderthal lower molar from Chagyrskaya Cave in Siberia, a procedure that predates similar interventions in Homo sapiens by more than 40,000 years and has been likened to the beginnings of a root canal. The tooth bears a deep, intentionally drilled hole that reaches the pulp, likely created with a stone tool—possibly a jasper perforator—to remove decayed tissue and relieve severe pain. Wear patterns show the individual survived and continued chewing on the tooth afterward. The cave has yielded the richest collection of artifacts in this part of Eurasia and is associated with the easternmost known Neanderthals closely related to the Micoquian industry, according to The Wall Street Journal.
"The concept of ‘This hurts, and I’m going to work on it, because if I get this out of here it’s going to feel better eventually.’ That’s something where you’re going to tolerate quite a lot of intervention in your mouth,” said paleoanthropologist John Hawks.
Analyses revealed fine parallel striations and V-shaped grooves inside the cavity, and micro-CT scans showed the pulp chamber was widened in a way inconsistent with natural wear or accidental damage. Experiments on modern and Holocene human teeth reproduced the same micro-traces by rotating sharp stone points, including perforators likely made of jasper and manipulated between the thumb and forefinger—an approach that could penetrate dentin in roughly 35 to 50 minutes of continuous effort. The generated marks match those on the Neanderthal molar, supporting that the drilling happened during life and with therapeutic intent. Smoothed edges and post-procedure wear indicate the patient regained function and continued to use the tooth. The tooth also shows characteristic scratches consistent with toothpick use on a lateral surface, a behavior seen elsewhere in the Neanderthal record and potentially tied to efforts to remove food or manage discomfort. Replication trials emphasize that drilling or rotating motions produced identical traces, strengthening the case that a small, sharp tool was used in a precise, controlled manner to expose and clean the pulp.
Extremely painful
To locate and treat the lesion, a Neanderthal had to diagnose the source of pain, reason that removing diseased tissue would help, select an appropriate tool, and drill with fine motor control. Such a procedure would have been extremely painful yet likely reduced infection and improved survival prospects. That points to cooperation—someone had to carry out or assist with the operation—and to a patient willing to endure intense discomfort in exchange for relief. The adult whose tooth was treated appears to have lived for a period after the procedure, with the functional wear and smoothed cavity edges consistent with a return to normal chewing. In aggregate, the evidence expands the catalog of advanced Neanderthal behaviors—already known to include caring for the sick, burying their dead, and creating art—to encompass invasive medical treatment guided by deliberate strategy and precise manual skill.
Excavations in the Altai Mountains have uncovered abundant stone and bone tools from 70,000 to 60,000 years ago, identifying the cave as a major Paleolithic hub for the region’s easternmost Neanderthals.
“The Surgeon Dentist”
The Chagyrskaya molar also sits within a long arc of oral care stretching deep into prehistory. Dentistry is regarded as one of the oldest medical fields, with roots traced to 7000 BC, and the modern form consolidating much later with the publication of “The Surgeon Dentist” in 1723. From a carefully rotated stone perforator to the first textbooks of clinical practice, the new evidence suggests that the intuitive logic of removing decay to ease pain has ancient foundations—and that Neanderthals possessed the cognitive capacity, manual precision, and social support to attempt it successfully, according to Scientific American.