Neanderthals had the know-how to identify a tooth infection and the motor skills to drill out the damage, according to a study published May 13, 2026 in the open-access journal PLOS One by Alisa Zubova of Peter the Great Museum of Anthropology and Ethnography, Russian Academy of Sciences (Kunstkamera), St. Petersburg, and colleagues.
Archaeological discoveries have shown that Neanderthals used toothpicks to remove food from their teeth and might also have used medicinal plants, but the extent of their medical capabilities is unclear. In this study, Zubova and colleagues describe a Neanderthal tooth which received physical alterations to treat infection.
This tooth is a single molar from Chagyrskaya Cave in Russia, around 59,000 years old. In the center of the tooth is a deep hole extending into the pulp cavity. The researchers conducted experiments on three modern human teeth to demonstrate that a hole of the same shape and same patterns of microscopic grooves can be created by drilling into the tooth with a stone point similar to tools that have been found within Chagyrskaya Cave. The hole in this damaged molar, as well as toothpick grooves along the side of the tooth, is an example of a caries lesion in the same population, which is rare among Neanderthals.
This procedure would have hurt, but it would also have ultimately alleviated the pain of a tooth infection by removing the damaged part of the tooth. These modifications provide evidence that Neanderthals had the capacity to identify the source of pain, to determine how to treat it, to apply the manual dexterity needed for an efficient operation, and to endure painful treatment to alleviate future discomfort. This is the first time such behavior has been demonstrated outside of Homo sapiens, and it is the oldest example of such behavior by more than 40,000 years.
The authors add: "This finding currently represents the world's oldest evidence of successful dental treatment. The damage documented on the Neanderthal tooth from Chagyrskaya Cave in Siberia points not only to intentional pulp removal but also to antemortem wear - wear that could only have developed if the individual kept using the tooth while alive. We also identified areas of demineralization where remnants of carious damage were preserved, further indicating that the concavity in the tooth was associated with treatment."
Alisa Zubova adds: "We were intrigued by the unusual shape of the concavity on the tooth's chewing surface. It differed from the normal morphology of the pulp chamber and did not match the typical pattern of carious lesions seen in Homo sapiens. Moreover, distinctly visible scratches suggested that the concavity was not the result of natural damage but of intentional actions."
"Computed microtomography revealed changes in dentin mineralization consistent with severe caries. Human manipulation of carious lesions has already been documented for the Upper Paleolithic, Mesolithic, and later periods. We therefore hypothesized that the damage we observed could also represent traces of such medical intervention - but from a significantly earlier period."
Lydia Zotkina adds: "To interpret the concavity on the occlusal surface of the tooth, we conducted experimental manual drilling on a series of specimens: a modern human tooth and two Homo sapiens teeth from a Holocene archaeological collection of uncertain temporal and cultural provenance. Comparison of the microscopic traces on the original Neanderthal specimen with those produced experimentally revealed a clear match. The findings demonstrate that drilling a carious lesion using a sharp, thin stone tool is entirely effective, permitting the rapid removal of damaged dental tissue."
Ksenia Kolobova adds: "Neanderthals arrived in this region 70–60 thousand years ago during a migration from Central and Eastern Europe and inhabited it until at least 40–45 thousand years ago. Altai became a new and suitable home for them thanks to its biological diversity, climate similar to that of Europe, abundant raw materials for stone tool production, and their usual prey - wild bison and horses. Analysis of stone tool industries and paleogenetic studies have shown that the Neanderthals from Chagyrskaya Cave are very closely related to the bearers of the so-called Micoquian industry, who also lived in the Caucasus and Crimea."
Author interview: https://plos.io/4uxLsJN
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Citation: 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
Author countries: Russia, USA, Uzbekistan.
Funding: This work was supported by the Russian Science Foundation Grant № 24-67-00033, "European Neanderthals in the Altai: migration, cultural and physical adaptation." The recipients of this funding award are Ksenia A. Kolobova, Alisa V. Zubova, Lydia V. Zotkina. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
