60,000-Year-Old Neanderthal Tooth May Reveal a Prehistoric Root Canal

A Neanderthal molar with an unexplained cavity

A 60,000-year-old Neanderthal tooth recovered from a cave in what is now Russia has a deep cavity that decay alone cannot account for.

The specimen is a molar from the lower-left jaw of a Neanderthal, an extinct human relative. This prehistoric individual had a severe tooth infection, probably over an extended period.

At a time when obtaining food was already challenging and pain relief remained rudimentary, toothache severe enough to stop someone eating could have been a matter of survival.

For this Neanderthal, the pain must eventually have become serious enough that they were prepared to take drastic action to ease it.

Scientists from institutions across Russia suggest the suffering individual may have undergone a form of prehistoric root canal treatment: using a sharp stone tool to drill the tooth and remove its damaged pulp - or, more likely, having someone else carry out the procedure.

If the researchers’ interpretation is correct, it indicates that Neanderthals practised remarkably capable dentistry. They may have understood that an infected tooth could be saved by taking out the pulp while leaving the remaining structure in place.

The tooth "currently represents the earliest known evidence of intentional dental intervention", the team writes in its paper. Until now, that distinction had been held by Homo sapiens.

"When we first saw [the tooth], our initial thought was: this is probably just a tooth root where the crown had broken off naturally," archaeologist Kseniya Kolobova of the Russian Academy of Sciences told ScienceAlert.

However, Alisa Zubova, a dental specialist and anthropologist on the team, was unconvinced that this accounted for the unusually shaped cavity.

Evidence of deliberate Neanderthal dentistry

After examining the tooth surface more closely under a microscope, the researchers identified "clear linear marks typical of a rotating, drilling motion," Kolobova explained.

"We also saw that the cavity is actually made of three overlapping depressions," she said.

"That could no longer be explained by disease or accident. This was intentional, hands‑on treatment."

Naturally, Neanderthals had neither the accurate electric drills used in modern dentistry nor modern anaesthetics.

They would instead have had to work with materials available locally.

In this instance, the team considers a very fine, pointed fragment of jasperoid - a stone readily found in the surrounding environment - to be the likely tool.

It is already known that Neanderthals in this region of Russia were knapping jasperoid into other tool types at the time. Some such tools have also been recovered from Chagyrskaya Cave, where the molar itself was found.

"They made complex, asymmetrical bifacial knives, scrapers, and these small retouched points. The fine motor skills and technical knowledge were already there," Kolobova explained.

"So, did they look at a carious, painful tooth and suddenly invent a new tool? No, I doubt it. Instead, what they likely did was repurpose an existing tool design for a novel, highly specialized task."

Testing stone tools on infected teeth

To establish whether such a tool could perform the job, the researchers tried carrying out Neanderthal dentistry themselves.

They managed to drill into old teeth from anthropological collections, but the Neanderthal-style tools worked most effectively on a wisdom tooth that had recently been removed from the mouth of their own traceologist, Lydia Zotkina.

"Lydia's tooth… was as close as we could possibly get to the fresh, moist condition of a Neanderthal tooth still in a person's jaw," Kolobova said.

"She drilled into her own tooth using a replica of [a] Neanderthal stone tool. In our lab, we still make jokes about it: 'The most personal contribution to the project'."

Although the hard jasperoid points cracked several teeth, the team achieved results resembling those seen in the Neanderthal molar by using the stone in a careful, gentle rotating movement.

The paper also argues that the Neanderthal ‘drilling’ approach was "more advanced" than the method used by H. sapiens, who scraped decayed teeth in an effort to remove caries.

This is not a treatment most people would be eager to book, yet it is striking that prehistoric humans were testing such a "sophisticated" technique so long ago.

The finding joins growing evidence that Neanderthal culture extended well beyond outdated depictions of brutish cavemen. They buried their dead, decorated caves, looked after their communities and may even have experimented with medicine.

It also appears that, when faced with toothache, they were willing to endure severe short-term pain if it offered a better outcome over time.

"They conceptually transferred an existing technology to a completely new domain," Kolobova adds.

"That shows a remarkable level of cognitive flexibility."

The research was published in PLOS One.