Neanderthals treated a tooth cavity 59,000 years ago

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."

Fig 2. Chagyrskaya 64 molar tooth and its macro-features. 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; .
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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Patagonian Monsters - Cryptozoology, Myths & legends in Patagonia Copyright 2009-2026 by Austin Whittall © 

Were erectus curious, intelligent, and sensitive humans?

A recent publication by Barkai, R., and Shalata, M., 2026, describes the finding of Acheulean tools crafted by Homo erectus using stones that contained fossils, holes, and geodes, which made them wonder if these hominins were attracted to them for magical reasons, and ask if they were sensible, intelligent, and mystical beings. (Lower Palaeolithic Tools of Potency: Handaxes Shaped around Fossils and Other Extraordinary Features at Sakhnin Valley, Israel. Tel Aviv, 1–31. https://doi.org/10.1080/03344355.2026.2637187)

The paper's abstract notes that "The handaxes reported here are part of a larger collection of hundreds of tools bearing typical Levantine Lower Palaeolithic Acheulean characteristics. What makes these handaxes particularly noteworthy is that they were shaped around fossil imprints or other geological features embedded in the selected flint nodule.. While thousands of handaxes are documented from Lower Old World Palaeolithic sites, fossil-bearing handaxes are extremely rare and garner special attention. This collection of unique bifaces provides valuable insight into their makers’ technological and aesthetic preferences, worldviews and relationship with stone. We propose that these handaxes served as tools and mediators between humans and the cosmos, conceived as objects of potency enhanced by the primeval fossil imprints and unique geological features within the stone. The richly embellished rocky landscape of Sakhnin Valley, particularly with its abundant geodes, may have encouraged early humans to express their profound and extraordinary relationships with the cosmos via stones."

The authors note that the flint used to make tools was selected by the Homo erectus who lived in this area (500,000 to 200,000 years ago), and they mostly chose flawless stones, however "Only a few handaxes, about one-tenth of those recovered during our survey, exhibit fossil imprints or other geological features. In addition, these features are located at prominent and distinctive spots on the biface, mostly at the centre of one of its faces. It thus appears that the handaxe was shaped around this feature... We therefore assume that flint nodules bearing fossils and geological features attracted the attention of Acheulean knappers and were intentionally collected by humans, who valued these features for one reason or another. Similarly, we suggest that knapping was conducted to position these features prominently, emphasising their visibility when holding or displaying the handaxe." Below are some images of these remarkable tools.

Acheulean tools with fossils, geodes or other structures in them. Source

This article suggests that the some aesthetic advances noticed during the Acheulean period, like the use of ochre, and these fossils and geodes deliberately used to make handaxes shows that these ancestral humans were developing and evolving a more advanced cognition. The authors suggest that this change in their intelligence was promoted by a change in their enviornment during this period. After hundreds of millennia of stability, their typical prey, elephants dwindled, and they had to adapt to other megafaunal food sources. Anxiety set in, and they developed a new perspective, where a cosmovision evolved. Rituals, symbolism, and magic developed. Stones had life, they were tools for hunting, and for this reason, shapes and distinctive features would be highly appreciated as they held power, or "mana". Magic could help them hunt better.

The interesting part of this article is that it portrays erectus differently from the usual cold description given by archaeology, which tends to picture them as primitive, brutal, with a limited intellect, thick-skulled, low-foreheaded, semi-human creatures that were static in time: they made the same Acheulean stone tools for 2 million years without developing any new technology. This depiction tends to make us think of them as very dumb creatures. We even doubt if they managed to master the art of fire making or build boats.

When an incised shell was found back in 2014 (see post), reported by a paper published in Nature, that was 430,000 to 540,000-years-old, the only possible crator of the shell engraved with geometric patterns, was the Homo erectus since no other humans lived in that region at that time. This was the first discovery to suggest that symbolic thought, something believed to be unique to modern humans, like us and the Neanderthals, was also shared by our distant and ancient relative, the H. erectus.

I find it relevant because Homo erectus lived for almost 2 million years in Eurasia and Africa, adapting to a changing environment and developing stronger cognitive abilities, while we, the Homo sapiens have only been around for one-seventh of that time (just 300 ky since the first alleged remains of a H. sapiens were discovered in Morocco), and most of that time we weren't as smart as we are now.

As I wrote back in 2014: "A smarter H. erectus is interesting, it means that 500 kya they could have not only engraved mussel shells but also, dealt with the cold Arctic climate and walked across Beringia into the Americas." I still feel the same way. These people were hardy, intelligent, sensitive, and well adapted to their environments, from the cold climate of northern China to the hot tropical jungles of Java, Indonesia. They were survivors.

To be Continued: Homo erectus in Siberia 800 to 400 kya

As we will see in my next posts, there were ancient humans living in Siberia, at sites far north, in the cold regions not far from Beringia, 400 to 800 thousand years ago. Considering the timeline, they were ver probably erectus. These people had the time, the survival abilities, and the intelligence to move east, and may have been able to reach America.

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Patagonian Monsters - Cryptozoology, Myths & legends in Patagonia Copyright 2009-2026 by Austin Whittall ©