Although this post has nothing to do with the main theme of my blog, I decided to include it because it gives us a glimpse of the intelligence and humanity of Neanderthals. They were not lumbering semi-human brutes. They were human beings, just like us, with a brain and a mind similar to ours. In this post I will comment about a very recent publication about how a Neanderthal from the Chagyrskaya site in the Altai region of Siberia 59,000 years ago, perforated a molar to relieve the pain caused by a caries. The oldest example of dentistry on record.
The paper is the following: 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
Over the years, there have been studies (the links lead to the research that backs these statements) that suggest that the Neanderthal buried their dead, and took care of their elders and injured companions, disabled (Down syndrome) and, mended those that were sick. This implies some kind of elevated mental function, and compassion.
In this paper the authors analyzed a molar (one located on the lower left side of the mouth) which had a large man-made hole bored into it (see image) this hole was made while the individual was alive, and the person survived after it was done. It was perforated by using a stone "perforator" that drilled or rotated against the enamel of the tooth to reach the inner pulp and relieve the pain caused by the caries with "severe pulp exposure." This procedure was done without any type of anesthesia, and would have taken (based on the experiments conducted by the researchers) between 10 minutes and two and a half hours, but they point out that "the individual would have had little choice: remove the dentin or face potentially fatal consequences."
From Zubova et al., 2026
The authors point out that the procedure required "... two distinct types of manipulations requiring different tools, in addition to the drilling/rotating technique, necessitating complex finger movements, indicates that the Chagyrskaya Cave 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. These patterns bring Neanderthal behavior closer to modern humans and differentiate that behavior from the instinctive actions of other primates."
Interestingly, the enamel thickness on Neanderthal teeth is thinner than in human teeth, meaning that it is easier to perforate it and reach the pulp than in modern humans. The edges and walls of the perforation are smooth and rounded suggesting that the individual was alive during the procedure and that lived after it, using the tooth. The authors wondered if the hole had been filled with wax, resin, bitumen, tree sap or antiseptic herbs to serve as painkillers but a Raman spectroscopical test did not reveal the presence of other materials.
Yes, it must have been a painful intervention, and the aftermath was also painful as it resulted in " complete pulp exposure. On the one hand, this could have caused pain for some time; on the other hand, pulp exposure would have accelerated nerve destruction, after which the pain should have disappeared." Was it done by chance? or did these people know how to treat a caries?
The paper concludes that this molar "offers new insights into Neanderthal self-regulation, revealing their capacity for deliberate, sustained actions that required enduring pain – a behavior not documented in other higher primates, which typically rely on instinctive responses. While genetic evidence confirms that Neanderthals exhibited heightened pain sensitivity compared to Homo sapiens, their ability to engage in goal-directed behaviors involving pain tolerance suggests advanced volitional control. It can be argued, therefore, that Neanderthals exhibited volitional strategic goal-setting behaviors that may have aligned more closely with those of Homo sapiens than with non-human primates... challenging traditional distinctions in cognitive archaeology between anatomically archaic and modern members of Homo sapiens and highlighting their shared legacy of biological and cultural adaptations."
Closing Comments
Neanderthal were smart, compassionate, and human. By the way, the earliest Homo sapiens dental intervention discovered to date was in an individual from 14,160 to 13,820 years ago, who lived in Ripari Villabruna in Italy. This person shows evidence of enamel scraping on a caries more of a toothpicking procedure rather than a drilling one.
One can hardly imagine the pain suffered by countless generations of human beings before the discovery of analgesics and anesthesia. We are fortunate to live in the present time! I recall the scene in the movie "Castaway" (2000) where Tom Hanks, stranded on a desert island, in terrible pain due to an untreated toothache that he had prior to his trip that led him to the island, does away with the tooth using a rock as a hammer and the blade of an ice skate as a chisel, passing out after the procedure.
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