Published on: 2026-05-14
Source: Novosibirsk State University –
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Scientists from the Institute of Archeology and Ethnography of the Siberian Branch of the Russian Academy of Sciences and Novosibirsk State University have established that the first dental manipulation, related not to extraction but to the treatment of a tooth, was performed 59 thousand years ago by Neanderthals living in the Chagyrskaya Cave (Altai Krai). It was previously believed that representatives of this species were not capable of such complex actions and only possessed skills of primitive medicine.It is known that they cared for the sick, wounded, and elderly members of the group using medicinal plants, but evidence of dental manipulations until now has not been found. The results of their research were presented by scientists in an articleEarliest Evidence for Invasive Mitigation of Dental Caries by Neanderthals (“The earliest evidence of invasive treatment of caries in Neanderthals”), published in the journal PLOS One.
—The earliest known dental manipulations related to the treatment of caries were described in Homo sapiens of the Upper Paleolithic. The only “medical” actions reliably recorded on Neanderthal teeth so far are the use of toothpicks, presumably aimed not only at removing food particles from the interdental space but also at alleviating pain during periodontal inflammation. However, such traces were found not only in Neanderthals but also in the earliest known representative of the genus Homo, H. habilis, and were also observed in the Japanese macaque (Macaca fuscata).Therefore, we cannot conclude that toothpick marks themselves are a marker of developed cognitive models., — said the senior lecturer of the Department of Archeology and Ethnography of the Humanities Institute of Novosibirsk State University, leading researcher at the Institute of Archeology and Ethnography of the Siberian Branch of the Russian Academy of Sciences, candidate of historical sciencesLidiya Zotkina.
The lower left second molar of an adult Neanderthal with traces of deliberate artificial modification in the form of an incorrectly shaped cavity, extending to the bottom of the pulp chamber, was found in the Chagyrskaya cave (Altai Krai). It was discovered in a layer corresponding to an early settlement of the cave by hominids about 59,000 years ago. Thorough analysis of the tooth led scientists to conclude that the unusual cavity on the occlusal (chewing) surface of the tooth was deliberately created by a human and represents the result of a more complex and invasive dental intervention than the use of a toothpick.It was neither similar to a vital wear of the tooth, nor to the consequences of trauma or accidental damage during burial in a cultural horizon. Moreover, the pulp chamber looked empty upon visual inspection, even in the root area. This observation was confirmed in the section conducted by microtomography: the pulp was indeed absent, and the cavity in the tooth was not characteristic of any natural process — neither vital nor post-mortem. The sample was first studied by a candidate of historical sciences, senior researcher of the Museum of Anthropology and Ethnography named after.Peter the Great (Kunstkamera) RAS Alice Zubova. She suggested that the damages observed in her were connected with an external intentional action, which was carried out either by another individual or by the patient herself. In any case, a dental manipulation probably involving drilling took place. Later, scientists from the Institute of Archaeology and Ethnography of the Siberian Branch of the Russian Academy of Sciences and Novosibirsk State University joined the research.
—We conducted a traceological analysis, then our colleague Alexander Kulkhov from Saint Petersburg State University made a computer microtomography of the sample. This was followed by a series of experiments, as a result of which we found that this case is the earliest documented instance of treating caries, including drilling using a stone tool. The drilling marks indicated the use of a second instrument—a softer and thinner one.Evidence of two different types of manipulations, requiring complex finger movements, allowed us to conclude that Neanderthals from the Chagyrskaya Cave were able to intuitively determine the source of pain, understood that it could be eliminated, purposefully conducted effective dental interventions, and realized the necessity of enduring severe pain during such manipulations. Thus, it can be assumed that their cognitive abilities were higher than previously assumed., – explainedLidiya Zotkina.
To establish the technology of dental intervention and the instruments used in this procedure, scientists conducted a series of experiments. First, they performed a comprehensive morphological study of the tooth using tracing analysis, scanning electron microscopy, computer microtomography, and Raman spectroscopy. The results of these studies were used by scientists to develop and conduct experiments aimed at testing various possibilities for modifying its chewing surface.
—Three holes were drilled in the Neanderthal molar, two of which are located directly above the canals, and the third is slightly to the side, on the periphery. It is possible that the third hole was made by mistake or due to the inaccuracy of the instrument used, which, according to our assumptions, was a fine sharp stone tool of small size. Moreover, the manipulation was most likely performed by touch. This circumstance may indicate that this operation was done not just to remove some local carious damage on the surface of the tooth, but was aimed deeper to clean out the entire pulp.And this was done not just to relieve pain — for this, it could have been enough to simply remove the painful tooth — but for its healing. We can confidently assert that this procedure was successful — the threat of infection due to the inflammatory process was eliminated, and thus the “patient’s” life was saved. And the worn and smoothed edges of the socket testify that the person lived a long time after the surgery and actively used the treated tooth., — explained Lidiya Zotkina.
Researchers did not have the opportunity to use Neanderthal teeth in experiments for several reasons: the age is measured in tens of thousands of years, during which the samples underwent processes of mineralization, dehydration, and other changes. Manipulation was conducted on a “living” molar, so much “fresher” teeth were required. In addition, Neanderthal teeth represent great value for science, so any research that carries a risk of damage or destruction of valuable samples is ethically unacceptable.However, scientists have concluded that the dental procedure undergone by the Neanderthal can be reconstructed even when using Homo sapiens molars.
As experimental samples, scientists used two teeth of Holocene age from early settlements from undocumented archaeological collections of the Institute of Archaeology and Ethnography of the Siberian Branch of the Russian Academy of Sciences. The third sample was “fresh” — it was provided by one of the researchers who recently underwent the procedure of tooth extraction.
All experiments were conducted by Lidiya Zotkina, who has experience working with Paleolithic technologies, as well as with the making and use of stone and bone tools.
—Neanderthals had thinner tooth enamel than modern humans, and we took this fact into account during the experiments. Scientists tried to reproduce the conditions of manipulation as closely as possible. It was conducted in the patient’s mouth, so we fixed each tooth in a cork base. To simulate a moist environment, a small amount of water was added during drilling. At the same time, a tool made of jasper, found near the Chagyrskaya cave, was used.Other materials available to Neanderthals — wood and bone — were not used due to impracticality. Using the stone tools we made, we performed various scraping and manual drilling techniques on samples., — said the researcher.
Experimental modeling was conducted in three stages, each developed to achieve a specific goal. The first stage assessed the very possibility of using stone tools to create depressions in a molar by drilling or rotational action. During the second stage, manual drilling was reproduced using a stone tool to create two interconnected depressions in the dentin. The third stage involved the task of exposing the pulp chamber of the molar by drilling three interconnected depressions in the dentin. Each experiment lasted less than an hour.The first lasted a little more than 15 minutes, the second — slightly more than half an hour, the third took 50 minutes, since it was associated with penetration into the pulp chamber. Considering the thinner enamel, conducting similar manipulations on Neanderthals would have taken much less time — according to researchers’ estimates, from 15 minutes to half an hour. Probably, all this time the “patient” consciously endured severe pain.
The effectiveness of stone tools in tooth drilling and the very possibility of such an operation have been proven as a result of experiments.
—The study we conducted serves as convincing evidence of the very earliest documented case of invasive intervention in dental caries in the history of human evolution. This is evidenced by the almost complete removal of the affected tissues and the subsequent wear of the walls of the tooth sockets. We now know that Neanderthals had invasive therapeutic practices, significantly preceding skills and knowledge similar to those of Homo sapiens.It was previously believed that the first known dental intervention was performed on a Late Paleolithic Homo sapiens specimen from Ripari Villabruna (northeastern Italy) approximately 14,160–13,820 years BC. On this person’s tooth, traces of external intervention in the form of scraping were found, but these were limited to the enamel and minimally affected the dentin. Tomographic analysis showed that the tissue was demineralized. This could have contributed to the further progression of the disease and increased pain sensations.Manipulation conducted by Neanderthals from Chagyrskaya Cave is much more complex and effective in many ways thanks to the drilling process, — said Lidia Zotkina.
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