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 © 

An earlier Human - Neanderthal split? (400,000 years earlier!)

Aida Gómez-Robles published a paper in Science Advances three days ago (May 15, 2019 - Dental evolutionary rates and its implications for the Neanderthal–modern human divergence, Vol. 5, no. 5, eaaw1268 DOI: 10.1126/sciadv.aaw1268) in which she finds evidence that "support[s] a pre–800 ka last common ancestor for Neanderthals and modern humans unless hitherto unexplained mechanisms sped up dental evolution in early Neanderthals".

This is really remarkable, as it pushes the conventionally accepted date of divergence back in time from 400 to 800 thousand years ago.

This far older age was worked out by studying ancient Neanderthal teeth from the Sima de los Huesos site in Spain.

Gomez-Robles compared fossilised teeth from archaic hominins such as Australopithecus afarensis, Australopithecus africanus, Paranthropus robustus, Paranthropus boisei, and ancient ones such as Homo habilis, Asian specimens of H. erectus, a Sima de los Huesos H. neanderthalensis and of course, us: Homo sapiens, Other Neanderthal teeth from different sites in Europe were deliberatel left out of the comparative study.

The idea behind the comparison was to see how the shape of teeth in hominins changed over time. Gomez-Robles found that they evolve, and do so at a steady pace. This let estimate when each of these species split from each other.

The conclusion: "The simplest explanation of the results presented in this study is that Neanderthals and modern humans diverged before 0.8 Ma ago", our Last Common Ancestor (LCA) with Neanderthals dates back to 800,000 years ago.

Gomez-Robles goes on to spell out the implications of this more ancient split:

" If the phenotypic LCA of Neanderthals and modern humans was older than 800 ka, this would imply that all fossil hominins younger than this age are no longer valid candidates to occupy this ancestral position. Some fossils younger than this age, however, are frequently considered to be part of the last common ancestral species to Neanderthals and modern humans. These fossils, usually ascribed to Homo heidelbergensis, include European and African specimens, such as Mauer, Arago, Petralona, Bodo, Kabwe, etc., and maybe even some Asian specimens. If Neanderthals and modern humans diverged earlier than 800 ka ago, then all these fossils have to be related either to Neanderthals or to modern humans, or they can be part of a sister lineage to both of them. These fossils, however, cannot be ancestral to Neanderthals and modern humans because they would postdate their evolutionary divergence. An evolutionary relationship between these fossils and both Neanderthals and modern humans would be possible only if they were part of an older ancestral species that persisted in time as a relic species after the actual split of both lineages. Effectively, this scenario would mean that the H. heidelbergensis fossils are part of a sister group to Neanderthals and modern humans but that the evolutionary change from their putative ancestral populations did not involve speciation."

Of course, there are confounding factors that can explain the structural differences in teeth without requiring such an older age, for instance: the teeth evolved quicker in a small population of Neanderthals, isolated from other human groups, making them seem older while they are actually only 400 Ky old.

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Patagonian Monsters - Cryptozoology, Myths & legends in Patagonia Copyright 2009-2019 by Austin Whittall © 

Some Odd teeth in China

A paper (Late Middle Pleistocene hominin teeth from Tongzi, southern China, by Song Xinga, María Martinon-Torres and Jose MariaBermudez de Castro) reported that some teeth roughly 200,000-years-old found in the Yanhui cave in China, which were originally thought to belong to Homo erectus, may belong to some other hominin.

They have a mix of modern and archaic traits, which lack some characteristic features of H. erectus, but don't belong to Neanderthals either!

Since modern H. sapiens was still in Africa at that time, these teeth (because they are large) may have belonged to the mysterious Denisovan group.

Expect some surprising findings to come out of China in the coming years. Asia was teeming with "humans" long before the purported "out of Africa" migration took place. It may be the cradle of humankind.

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Patagonian Monsters - Cryptozoology, Myths & legends in Patagonia Copyright 2009-2019 by Austin Whittall © 

Atapuerca Sima de los Huesos remains were closer to the Neanderthals

Four and a half years ago I posted about a site in Spain, known as Atapuerca (What Science is all about), in it, I mentioned two studies that came to different conclusions: one stated that the human remains there resembled Neanderthals, the other that they were closer to the Denisovans than to the Neanderthals.

Today I read a paper that was published on Nov. 30, 2018 and which states that the teeth of remains from Atapuerca's Sima de los Huesos site shows that they had a close relationship to the later Neanderthal groups found in Europe.

The paywall protected abstract says:

"Enamel and dentin patterns have awakened a considerable interest in phylogenetic studies. However, almost nothing is known about the dental tissue proportions of European Pleistocene hominins, apart from Neanderthal populations. This study aims to assess the three-dimensional dental tissue proportions of permanent canines belonging to the extensive sample of hominin teeth at Sierra de Atapuerca (Spain) through the use of microtomographic techniques. Our results show that early and middle Pleistocene populations from Atapuerca exhibit large coronal and root dentine dimensions, as well as a thinly enamelled pattern, which has been traditionally considered an autapomorphic Neanderthal trait. Therefore, these results might support an early enamel thickness decrease which is already observed 800 kyr ago in Homo antecessor and maintained in later groups such as Sima de los Huesos and Neanderthal populations during the middle Pleistocene."

This is important because it shows that the Sima de los Huesos remains had a close relationship with the Homo neanderthalensis.

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Patagonian Monsters - Cryptozoology, Myths & legends in Patagonia Copyright 2009-2018 by Austin Whittall © 

45 KY old African teeth from Magubike with Neanderthal and H. erectus traits...

This paper Middle Stone Age human teeth from Magubike rockshelter, Iringa Region, Tanzania, by Pamela R. Willoughby, Tim Compton, Silvia M. Bello, Pastory M. Bushozi, Anne R. Skinner and Chris B. Stringer. Published: July 31, 2018https://doi.org/10.1371/journal.pone.0200530, discusses human teeth found in Africa:

They are significant because they come from Tanzania (the Magubike rockshelter) and are apparently fom Middle Stone Age (MSA) deposits dated and a "conservative estimate of their minimum age is 45,000 years" according to the paper.

As we all know, finding human remains in this part of Africa, especially those from the Middle Stone Age (which took place between 320,000 and 30,000 years ago) is a very rare event.

The authors try to find similarities between these ancient teeth and the San people (the San are always mentioned because they are assumed to be a "relict" of the original Homo sapiens that left Africa, the "oldest" extant humans, the "most diversified" members of our species.

And they say so, albeit cautiously, in this paper: "... a number of characteristics in the Magubike teeth suggest possible San affinities.".

But as we go into the details, it seems that these teeth are indeed quite unique, and, in my opinion, not at all like those of the San people:

Quoting the authors: (bold is mine)

"In summary, the Magubike teeth have the characteristics typical of African sub-Saharan Homo sapiens Holocene teeth, but aspects of the morphology of the upper canine and third premolar are atypical for the African mid/late Pleistocene sample. However, this may be at least partly due to its North African bias. Certain traits present ― e.g. the root shape of the lateral incisor and canine, and the presence of a cingulum pit on the lateral incisor ― are rare or absent in the comparative samples. Traits specific to Homo heidelbergensis / archaic Homo sapiens and Aterian teeth are not present. Despite their large size, there is some suggestion of San affinities, though this interpretation must be very tentative, being based on a single individual."

The interesting part is the similarity with Neanderthal and Homo erectus features: (again bold is mine)

"... The pronounced buccal vertical curvature of the canine root found at Magubike is seen in early teeth, Homo erectus and Neanderthal [22, 47], but not in samples of early modern Homo sapiens (Skhūl and Qafzeh) or European Upper Palaeolithic Homo sapiens[48].
In recent teeth, the buccal surface is usually straight or has a mild curvature [49]. The few canine roots that could be observed in the Kenyan early Holocene sample, and the two in the Gwisho sample, are straight, and in the mid/late Pleistocene sample only the Broken Hill canine has similar curvature to that of the Magubike canine."

In other words it is not found among early modern Homo sapiens, only in Neanderthals and H. erectus. The authors continue, finding some examples of curvature in recent African samples (7% of them - a low figure) which may have come from out of African migrants in more recent times...:

"However, four instances were found in the recent sub-Saharan East/South African sample (7%). Similarly, the incomplete root of the Magubike lateral incisor has pronounced buccal vertical curvature in contrast to the more evenly tapered form of recent teeth [50]. A lateral incisor of this form occurs at the Klasies River Main site [51] and in one of four in the Gwisho sample, but in just one out of seventy-five in the recent East/South African sample."

As we see in the preceden paragraph, there are yet more morphological traits that are not at all related to modern African samples.

And the authors admit the teeth's unusual uniqueness very clearly:

"The six Magubike teeth are differentiated from African archaic Homo sapiens / Homo heidelbergensis and Aterian teeth in terms of size and the lack of morphological traits that could be associated with these groups. They are also differentiated from the Kenyan early Holocene and Gwisho samples and more recent teeth in terms of the relative size of the incisors, the incisor crown heights, the relative crown heights of the two premolars, and the long premolar roots. However, the morphological evidence is contradictory, principally in relation to the canine having traits that are rare or absent in the African mid/late Pleistocene sample, though this may be partly due to the small size of this sample and its North African bias."

They attribute this to the small sample size and its "North African bias"

But why try to find them similar to San teeth? Well, orthodoxy requires it: oldest African remains of a Homo sapiens and "oldest" extant humans (SAN) "must" be related:

"Small bodied individuals recovered from East African LSA sites have often been described as having “Khoisanoid affinities”, implying an assumed connection with the small bodied people of South Africa, including the San [75]. There are also still people in northern Tanzania today whose languages are often related to Khoisan (the Hadzabe and Sandawe), implying some possible past connections with southern African peoples [78]."

But what if... the teeth resemble Homo erectus and Neanderthal teeth because these migrated INTO AFRICA? As we can see they don't resemble the African teeth of that time or those of early Modern Homo Sapiens...

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Patagonian Monsters - Cryptozoology, Myths & legends in Patagonia Copyright 2009-2018 by Austin Whittall © 

On the genes that regulate teeth, archaic hominins and Africans

A paragraph in this paper: Neanderthal and Denisova tooth protein variants in present-day humans) by Clément Zanolli , Mathilde Hourset, Rémi Esclassan, Catherine Mollereau (Published: September 13, 2017https://doi.org/10.1371/journal.pone.0183802) caught my eye. It pointed out an anomaly: Africans sharing a trait with Neanderthals and Denisovans!

This is what it says:

"The finding in living Africans of rare derived polymorphisms that were present in Neanderthals (Fig 2: ENAM G389S, 5%) or Denisova (Fig 3: CEMP1 R80H, 0.5%) is difficult to reconcile with the fact that interbreeding of AMH with Neanderthals occurred out of Africa [75, 76]. However, as mentioned above, this could be explained by the inside Africa admixture between the ancestors of AMH and archaic hominins, or by the possible back migration of Neanderthal gene flux. Further genome analysis of the Neanderthal and Denisova polymorphisms in AMBN, ENAM, and CEMP1 certainly deserves attention as they could trace back an African ancestor common to Neanderthals, Denisova and early anatomically modern humans."

Well, it is not "difficult to reconcile" if the fact is wrong and AMH interbred with Neanderthals inside Africa...

The ENAM G389S variant is found not only in Africa at 5% but also at very low frequencies in the Americas 0.3% (maybe imported by African slaves or perhaps a genuine Amerindian-Neanderthal admixture). Its global prevalence is only 1.3% and is virtually absent in Asia and Europe. Denisovans carried the ancestral "G" type, found in chimps and gorillas. Neanderthals and modern humans carry the derived "S" type.

They also found a some proteins in Denisovans (K55 E variant) that appear at 26% frequency among Africans and 7% globally (the highest outside of Africa being in America at 2% and far lower elsewhere). This is the ancestral type, found in Denisovans, chimpanzees and modern humans, but it was not found in Neanderthals.

The paper also hints at an admixture in Africa between H. Sapiens and some archaic homo 35,000 years ago:

"Most of the amino acid changes are found in the dentin and enamel proteins that are encoded by genes located in two close clusters on the chromosome 4 (Fig 4) and supposed to derive from an ancestral gene encoding a secretory calcium-binding protein [68]. These clusters fall apart from known haplotypes on chromosome 4 and do not correspond to candidate Neanderthal or Denisovan gene flow regions in non-African living humans [69, 70]. However, a signal of archaic introgression in the locus 4qMB179 on chromosome 4 has been evidenced in Central African populations, and is supposed to result from admixture with an archaic Homo some 35 kya [71]."

Admixture with archaic hominins in Africa would "enrich" the diversity of African DNA and therefore contradict the prevailing theory that Africans are more diverse and therefore they are the "original" source of humanity.

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Patagonian Monsters - Cryptozoology, Myths & legends in Patagonia Copyright 2009-2018 by Austin Whittall ©