Your patients may not have anything to complain about.
A single lower molar recovered from Chagyrskaya Cave in Russia's Altai Mountains has upended the timeline of dental history. According to a study published earlier this month in PLOS One, the tooth, named Chagyrskaya 64, dating back approximately 59,000 years ago, bears the earliest documented evidence of deliberate caries intervention in human evolutionary history, predating the previous oldest known dental treatment by roughly 45,000 years.
The tooth belonged to an adult Neanderthal and featured a large, irregular cavity extending into the pulp chamber, occupying most of the occlusal surface. What distinguishes it from other carious Neanderthal teeth, however, are scratches around the lesion, suggesting deliberate use of a tool. Microtomographic and traceological analyses confirmed drilling and rotating motions consistent with a small, fine-pointed stone perforator -- examples of which, made from locally sourced jasper, were found at the same site.
Fig 1. General view of the tooth in five projections. (a–c) Macro-photographs of the crown’s occlusal surface features: (a.) superior view of the concavity; (b.) stepped groove on the concavity’s wall; (c.) cross-sectional profile of the groove.Images and captions courtesy of Zubova et al. Licensed under CC BY 4.0 International.
Experimental verification
To confirm the hypothesis, the research team used replica jasper tools to reproduce the procedure on three modern human molars under simulated intraoral conditions, applying a small amount of water to each tooth. A researcher successfully reached the pulp chamber in under an hour using manual drilling alone, reproducing the scratching patterns observed in the Neanderthal specimen.
Wear patterns on Chagyrskaya 64 indicate the individual continued chewing on the tooth after the procedure, suggesting at least partial functional success. Drilling to the pulp would have deadened the nerves and blood vessels, providing pain relief.
“This finding currently represents the world's oldest evidence of successful dental treatment. The damage documented on the Neanderthal tooth from Chagyrskaya Cave in Siberia points not only to intentional pulp removal but also to antemortem wear - wear that could only have developed if the individual kept using the tooth while alive," wrote the study's lead author, Alisa V. Zubova, PhD, a senior researcher at the Peter the Great Museum of Anthropology and Ethnography at the Russian Academy of Sciencesin St. Petersburg, Russia, with co-authors from the Institute of Archaeology and Ethnography of the Siberian Branch of the Russian Academy of Sciences.
Implications for understanding Neanderthal cognition
The study's authors point out key anatomical differences between Neanderthal teeth and modern human dentition. Neanderthals had comparatively thinner enamel spread over a larger area and a more enlarged pulp chamber. The study's authors acknowledge that performing such a procedure on an obliging patient, coupled with inflammation and swelling, would have been challenging.
Cavities were relatively uncommon among Neanderthals, whose richer oral microbiome and low-carbohydrate diet resulted in fewer cavity-causing bacteria compared to later agricultural populations. The authors surmise that a family member likely performed the procedure on the tooth's owner.
"Neanderthals possessed the cognitive capacity to intuit the source of pain, comprehend the feasibility of its elimination, and deliberately select the most efficacious dental intervention," wrote the study's authors.
Fig 2. Retouched points (1, 4) and perforators (2, 3, 5) from Layer 6c/2 in Chagyrskaya Cave.Images and captions courtesy of Zubova et al. Licensed under CC BY 4.0 International.
Dr. Gregorio Oxilia of LUM University Giuseppe Degennaro in Italy, who previously studied scraping-based caries treatment in a Homo sapiens individual from approximately 14,000 years ago, called the new finding a milestone for both anthropology and evolutionary dentistry. The Chagyrskaya Cave evidence, he wrote, documents a transition from instinctive self-medication -- also observed in non-human primates -- to a deliberate, invasive medical strategy, and it suggests that interventional dental care is not exclusive to Homo sapiens.
