A Neanderthal With a Toothache May Have Invented Dentistry 59,000 Years Ago

Neanderthal dentists used stone drills to treat cavities nearly 60,000 years ago,

A battered molar from Chagyrskaya Cave in Siberia may preserve the earliest known evidence of invasive dental treatment — performed not by modern humans, but by a Neanderthal.

A new study suggests that about 59,000 years ago, someone used a small stone tool to drill into a badly decayed tooth, remove diseased tissue and expose the pulp chamber. The patient may have done it himself, or allowed another Neanderthal to do it. Either way, the procedure points to a striking level of skill, pain tolerance and practical medical understanding.

Stone Age Dentistry

The pain this Neanderthal felt must have been excruciating. By the time archaeologists found it in Chagyrskaya Cave, in the Altai Mountains of southern Siberia, the molar had lost nearly all of its crown. Its enamel was gone and the chewing surface had been worn flat by a hard life and a hard diet.

But when researchers looked at this under microscopes and CT scans, they started to realized that it wasn’t all natural damage. There were clear signs of treatment; a painful, invasive effort to remove decay and offer pain relief, done roughly 59,000 years ago.

“This was created intentionally by a human hand, specifically by a Neanderthal, using a small, pointed lithic tool, likely a perforator made of local jasper,” said study author Lydia Zotkina.

The team considered other explanations: age-related attrition, trauma, post-mortem damage. But the shape of the cavity just didn’t match the normal outline of a worn pulp chamber, and the tooth lacked the scattered scratches you’d expect from geological abrasion. Instead, marks were concentrated around the cavity. There’s no way this would have been done by accident. This was a treated tooth.

“The shape and micro-traces show that the technique involved drilling or rotating motions, not just scraping or picking,” Zotkina added.

The Operating Room Was a Cave

The procedure would have been brutal. The infected tooth likely caused a great deal of pain. The intervention itself opened the pulp chamber with a stone point, which in the moment, would have been extremely painful. But the Neanderthal endured it.

“I can say that what struck me, and continues to strike me, is what an incredibly strong-willed person this Neanderthal must have been. 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,” says Zotkina.

The study can’t say whether the dental intervention was self-performed or carried out by another Neanderthal. But in both cases, this was a planned operation, and a very complex one.

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“This was not a sterile operating room, but it was a deliberate, goal-oriented act. The mouth is a difficult space to work in; you need good manual dexterity, patience, and a helper who can hold the head still.”

Stunningly, the operation may have worked, at least partly. The treated tooth shows signs of later wear, meaning it remained in use after the painful intervention, but the isolated molar cannot reveal whether the infection eventually healed or spread deeper into the jaw. Exposing the pulp may also have destroyed nerves and reduced pain afterward.

“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. We have never encountered anything like this before – neither among Neanderthals nor among modern humans from much later periods,” co-author Alisa Zubova mentioned.

What This Says About Neanderthal Minds

Evidence for Neanderthal “medicine” was already building before. Researchers have long pointed to Neanderthals who survived serious injuries, illness, and old age — survival that likely required food sharing, protection, and social care. There were also hints of medicinal plant use and a form of natural antibiotic repeated toothpick marks that may have helped relieve oral pain. But this is a whole different story.

Treating a tooth thusly requires a diagnosing the problem, selecting (and creating) an appropriate tool, and then performing a painful and invasive action. The procedure itself required more than random poking. It required locating pain, choosing a tool, applying force carefully, and continuing through what must have been a horrible experience.

“That is active, targeted medical intervention,” said co-author Ksenia Kolobova.

In fact, the team even tried to replicate the procedure, which confirmed just how difficult it was.

Recreating a Neanderthal Operation

Obviously, the team couldn’t try the procedure on a volunteer. Instead, they used modern human molars and small tools made from local jasper. They tried to recreate similar tools to the ones previously found at Chagyrskaya Cave. They tested scraping versus rotating/drilling motions. Scraping did not work well, but using the stone point like a hand drill quickly produced depressions in dentin. In one experiment, they reached the pulp chamber in about 50 minutes.

They also tried to make the experiment biologically plausible by adding water to simulate the moist conditions of the mouth and securing the teeth in a stable base. Already, this required some serious concentration from the researchers; and this setup isn’t nearly as complex as the human mouth.

“What surprised me most was the technical sophistication. When Lydia experimentally replicated the procedure on modern human teeth, she needed concentration and fine motor control. Keep in mind we could not fully recreate the actual conditions – 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.”

During all of this, the patient had to stay reasonably still, which involved a great deal of trust and understanding.

“Now, every time I go to the dentist, I think about that guy,” Zotkina quipped.

What a Tooth Can Say About a Mind

Scientists have already moved from the “Neanderthals were brutes” theories. They were every bit as intelligent and sophisticated as Homo sapiens, if not more so.

But the Chagyrskaya Neanderthals suggest that perhaps, they were even more impressive. Treating a diseased tooth isn’t just like feeding someone or caring for an elderly person. It shows an understanding of the body (and of the self) that we may have under-estimated.

“Now it is clear that Neanderthals understood something deeper: that their own bodies could and should be altered, or repaired, when injured or diseased. This tells us that the emotional and conscious parts of the Neanderthal mind operated independently, just as they do in modern humans. They did not see their bodies solely as a construct handed down from above, but as a material object that could be acted upon,” says Kolobova.

We don’t know if this was an extremely rare case (perhaps an outstanding Neanderthal surgeon) or if it was common knowledge. Researchers say previous finding should be re-examined to look for signs of similar procedures. But this does show tens of thousands of years, Neanderthals were performing dental surgery; and the implications are stunning, Zotkina concludes.

“Our findings show that understanding the causes of toothache from caries and knowing how to treat it was already possible tens of thousands of years ago, it just never became common. Perhaps the person who owned this tooth was unique in his grasp of the disease. Or perhaps his knowledge simply got lost because it wasn’t needed in a Neanderthal world where caries were extremely rare. In the end, this is the first time we have encountered a case where the right idea for treating a disease arrived about 60,000 years ahead of its time.”

Journal Reference: Zubova AV, Zotkina LV, Olsen JW, Kulkov AM, Moiseyev VG, Malyutina AA, et al. (2026) Earliest evidence for invasive mitigation of dental caries by Neanderthals. PLoS One 21(5): e0347662. https://doi.org/10.1371/journal.pone.0347662

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