This may be the earliest evidence of Neanderthal ‘dentists’
A hole drilled into a 60,000-year-old molar suggests that Neanderthals practiced complex dental care long before modern humans.
Humans often depict our closest relatives, Homo neanderthalensis, as club-wielding brutes who acted on instinct instead of thought. But recent evidence suggests these so-called “cavemen” were cerebral creatures capable of artistic expression and honoring their dead.
Now, a new discovery suggests that Neanderthals also displayed a deft touch when treating dental pain. A team of researchers recently examined a peculiar hole inside a nearly 60,000-year-old Neanderthal molar found in a Siberian cave. Their findings, published Wednesday in the journal PLOS One, suggest that a tool-wielding Neanderthal drilled into the tooth to carefully remove its damaged core. The prehistoric procedure predates the earliest evidence of modern humans drilling into cavities by some 40,000 years.
“Discoveries like this one drive the final nails into that old caricature,” says Andrey Krivoshapkin, a paleoarchaeologist at the Russian Academy of Sciences’ Institute of Archaeology & Ethnography and a coauthor of the new paper. “This moves beyond simple hygiene into the realm of active medical treatment.”
The new finding also reveals insights into Neanderthal cognition, says Penny Spikins, an archaeologist from the University of York in England, who studies how early humans cared for one another, but was not involved in the paper.
The remedied molar, she says, provides evidence that Neanderthals could pinpoint sources of pain and work together to remedy them. Spikins adds that the work illustrates that Neanderthals showed a “willingness to do something actually quite difficult—to make someone’s pain worse in order to resolve it in the long term.”
Treasure trove of teeth
Researchers discovered the modified molar in Chagyrskaya Cave, in southwestern Siberia’s Altai Mountains. Around 60,000 years ago, this area was home to cave hyenas, woolly rhinos, and wolves, as well as a hardy population of Neanderthals living towards the eastern boundary of their species’ range. These Paleolithic locals wielded stone hand axes and lived with their relatives—a 2022 paper found that the ancient inhabitants of Chagyrskaya Cave included a father-daughter duo.
Chagyrskaya Cave is one of the few places in Central Asia to yield Neanderthal fossils. The species went extinct in the late Pleistocene around 40,000 years ago.
Since 2007, scientists have excavated more than 70 hominin fossils buried below the cave’s dusty floor, including part of a lower jaw, several skeletal fragments, and dozens of teeth, several of which are riddled with cavities.
Scientists have learned a tremendous amount about how Neanderthals lived by studying their teeth. For example, traces of starch in the tartar plastered on Neanderthal teeth reveal that plants were part of the paleo diet for these ancient humans. Neanderthals also took care of their chompers. A 2013 paper discovered that a Neanderthal in Spain may have used an ancient toothpick to remove food particles and relieve gum pain.
Confounding cavity
According to Krivoshapkin, the true “eureka moment” at Chagyrskaya often occurs after the fossils return to the lab and are examined under the microscope. That was the case with the specimen known as the “Chagyrskaya 64 molar.” The tooth, which was once lodged in the lower left corner of an adult Neanderthal’s mouth, had a deep abscess running from the crown into the pulp cavity.
(Were Neanderthal men the Romeos of the prehistoric world?)
The team initially thought the cavity was caused by natural wear or weathering. However, when Alisa Zubova, an anthropologist at the Russian Academy of Sciences and the lead author of the new paper, examined the specimen under a microscope, she noticed something odd. Instead of being a singular hollow abscess, the hole was composed of three partially overlapping pits. This structure was not only distinct from the usual cavity, but it also differed from the jagged gaps that occur when a tooth breaks due to trauma.
To get a closer look, the team used a micro-CT scanner to analyze the abscess in microscopic detail. This revealed tiny scratches wrapped around the walls of each pit. These grooves were oriented in the same direction, which “is exactly what you would expect from a rotating or drilling motion with a hard, pointed stone tool,” Krivoshapkin says.
Tools of the trade
To test their hypothesis, the team attempted to recreate these peculiar pits.
They used ancient stone-knapping techniques on jasper rocks found around Chagyrskaya to create small, pointed tools only a few centimeters long. They tested these tools on a trio of modern human teeth. One of the researchers, Lydia Zotkina, even provided her own recently extracted wisdom tooth for the experiment.
The team placed the teeth in small amounts of water (to mimic the mouth’s moist conditions) and twisted the tools by hand to drill into the teeth. Because jasper is harder than dental tissue, the sharpened tools left holes within minutes. The scientists had to be careful, though, as putting too much pressure on the tools risked shattering the entire tooth.
The researchers then compared the resulting holes to the pits seen on the Neanderthal molar. The holes the researchers drilled closely matched the odd shape of the fossil’s abscesses, and micro-CT scans of the fresh holes revealed similar grooves that were nearly the same exact size as those observed inside the “Chagyrskaya 64 molar.”
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The experimental work was crucial for showing that paleolithic tools possibly left behind the complex cavity in the molar, says Marina Lozano, a paleoanthropologist at Spain’s Catalan Institute of Human Paleoecology and Social Evolution, who was not involved in the new paper. She notes that while Neanderthal molars are slightly larger and denser than those of modern humans, the ancient ailment afflicting the Chagyrskaya molar likely made the tooth’s enamel brittle.
“I imagine that when the Neanderthal made the hole in the cavity on this tooth, it was easier to drill,” Lozano says.
The “Chagyrskaya 64 molar” suggests that the procedure was a success in removing the damaged portion of the ancient tooth. If the Neanderthal had died shortly after the operation, the walls of the freshly drilled pits would have been rough. Instead, the grooved walls were largely smooth, indicating that food and plant fibers polished the insides of the tooth as the individual continued to chomp away, Krivoshapkin says.
The tooth repair also shows that Neanderthals were not simply seeking a quick fix; instead, they were willing to endure short-term pain for long-term gains.
“This treatment [would] have initially increased the tooth pain,” before relieving it in the long term, says Spikins, the archaeologist from York University. “This shows some level of understanding of how to relieve pain in the long-term, not simply the equivalent of immediately scratching an itch.”
Undergoing such a painful procedure is particularly impressive given that genetic research suggests Neanderthals had greater sensitivity to pain than modern humans. To Krivoshapkin, letting another Neanderthal drill into an infected tooth would have taken guts.
“That is not instinct,” he says. “That is willpower.”
