The earliest known "patient" survived, kept chewing, and left behind what is now believed to be the oldest evidence of deliberate dentistry, performed in a Siberian cave 59,000 years ago.
By DOCS Incisor Staff
For decades, the oldest evidence of intentional dentistry pointed to the ancient world, somewhere around 5000 BCE. However, a single Neanderthal molar just pushed that timeline back more than 40,000 years. Unlike soft tissues, ancient teeth often provide durable records that last hundreds or even thousands of years, and this one bears the marks of a deliberate procedure performed deep in the Stone Age.
A New Understanding of Neanderthal Medicine
There's already plenty of evidence that Neanderthals provided medical care for each other. In fact, fossilized remains from the Late Pleistocene show they likely cared for disabled community members, and in at least one case, a Neanderthal lost an arm to amputation. For instance, one of the clearest examples of that care is Shanidar 1, a Neanderthal man from what's now Iraq who lived into his 40s despite deafness, a missing forearm, and a limp. Injuries like his would have left him vulnerable, but reaching old age meant he depended on the people around him.
Paleolithic hominids also had some understanding of how to address oral problems. Previous finds showed traces of toothpicks and other improvised tools used to remove food debris or relieve tooth pain. However, because modern monkeys use similar strategies, archaeologists were reluctant to count this as evidence of what they call "intentional dentistry." New research published in PLOS One earlier this month changes that theory.
What a Second Molar Tells Us About Neanderthal Dentistry
Among skeletal remains found at Chagyrskaya Cave in Russia, one lower second molar stood out. The heavily worn tooth shows signs of intentional drilling to expose and then remove the pulp. Microscopic and spectroscopic analysis revealed striations consistent with a sharp stone tool twisted against the tooth, the Stone Age version of a dental drill. Researchers concluded that someone had performed a root canal roughly 59,000 years ago, and the wear patterns on the tooth show the patient kept using the molar afterward.
The cavity itself was unusual for its time. In fact, caries rarely appear in Neanderthal remains, so finding two cases in a small group at Chagyrskaya caught researchers' attention. They suspect the cause had less to do with diet than with specific cavity-causing bacteria in the population's mouths.
What Tools Did Neanderthal Dentists Use?
Artifacts found at the site include points and perforators made of jasper and other hard stone. Using them would have required complex, precise manipulation to work slowly through the tooth. The concavity is also composed of three connected depressions, which suggests the work was done in stages, possibly over more than one sitting.
Anthropologist John Olsen, who collaborated on the study, told the New York Times the job probably took more than one person. Reaching a back molar at the right angle likely called for a second Neanderthal to do the drilling and a third to hold the patient's head still. As Olsen described it, "Let's have Aunt Sue hold your head in her lap while I actually do the work."
Olsen noted that Neanderthals kept medicinal plants around them, but he believed none of those remedies would have done much against the pain. A root canal, he expects, would have been "gruesomely painful." Furthermore, the study found Neanderthals likely felt pain more intensely than modern humans do, which makes the patient's endurance even harder to imagine.
How Did They Seal the Tooth?
The treated tooth lasted tens of thousands of years, but any filling material broke down long before researchers got to it. Their best guesses point to beeswax, pine pitch, birch tar, or another organic material with antiseptic properties. Spectroscopic analysis, however, turned up no trace of a sealant.
The molar tells us that a Neanderthal recognized a suffering member of the group, traced the source of the pain, and chose to act. That kind of deliberate reasoning was long considered uniquely human in the modern sense. However, this discovery suggests Neanderthals were capable of compassion, caring for one another, and even performing root canals long before previously thought.
References
- Zubova, A. V., Zotkina, L. V., Olsen, J. W., Kulkov, A. M., Moiseyev, V. G., Malyutina, A. A., Davydov, R. V., Markin, S. V., Maksimovskiy, E. A., Chistyakov, P. V., Krivoshapkin, A. I., & Kolobova, K. A. (2026). Earliest evidence for invasive mitigation of dental caries by Neanderthals. PLOS ONE, 21(5), e0347662. https://doi.org/10.1371/journal.pone.0347662
- Lidz, F. (2026, May 19). Neanderthal dentistry, and the scientist glad not to have experienced it. The New York Times. https://www.nytimes.com/2026/05/19/science/neanderthal-tooth-dentistry.html
- Trinkaus, E., & Villotte, S. (2017). External auditory exostoses and hearing loss in the Shanidar 1 Neandertal. PLOS ONE, 12(10), e0186684. https://doi.org/10.1371/journal.pone.0186684
- American Dental Association. (n.d.). History of dentistry. ADA Library and Archives. https://www.ada.org/resources/ada-library/dental-history
