Neanderthals drilled cavities to treat a toothache 59,000 years ago

The world’s first dentist was a Neanderthal, according to a recent study.

59,000 years ago in what’s now southwestern Siberia, a Neanderthal had a toothache. It must have been a doozy because they were desperate enough to sit still while someone drilled into the tooth with a sharp stone tool, removing the infected tissue and ultimately relieving the pain.

The process left behind a hole in the tooth that paleoanthropologist Alisa Zubova of the Russian Academy of Sciences and her colleagues recognized, tens of millennia later, as dental work. Archaeologists unearthed the tooth at Chagyrskaya Cave in Russia, and it’s now the oldest known evidence of dentistry—or any direct medical treatment.

This tooth is the world’s oldest evidence of dentistry, or any other medical procedure, for that matter.

Credit: Zubova et al. 2026

Experimental archaeology in action

The tooth, found in a layer of sediment laid down 59,000 years ago, is an upper third molar with an unusually large hole in the chewing surface, reaching all the way down into the pulp chamber—the protected inner space of the tooth that houses the nerves and blood vessels. Around the edges of the hole, Zubova and her colleagues noticed scratches, which, in addition to the hole’s unusual size and shape, made the archaeologists wonder if it had been drilled intentionally to relieve the pain of a tooth infection. That possibility “demanded special analysis,” said Zubova in an interview with PLOS.

Drilling a hole in a tooth to relieve pain sounds counterintuitive at first, but it’s the easiest, least destructive way to remove the infected tissue. Exposing the pulp chamber leads to the death of the exposed nerves, which takes away the pain. This didn’t become common practice until a few hundred years ago, but at least one Neanderthal apparently figured it out and convinced someone to go along with it.

To test whether the hole was made intentionally, Zubova and her colleagues examined the tooth more closely with scanning electron microscopes, micro-CT, and Raman spectroscopy, a technique for identifying the chemical makeup of an object. They also made their own stone drilll or perforator (a sharp stone tool that would have been used to drill or punch holes in hides, bone, and other materials) and tested it on three human teeth.

Two of the teeth were museum specimens, whose age and context curators didn’t know, making them less useful for other kinds of research. But one, an upper left third molar with an untreated cavity, came straight from the mouth of one of the authors—for science!

(In most scientific papers, a section at the end outlines the specific contributions of each author, which usually means tasks like writing, data collection, production of stone tools, and analysis. This paper’s author contributions did not list “donation of a tooth for experimental archaeology,” so we can only speculate about who bit the proverbial bullet.)

The holes and striations left behind by Zubova and her colleagues’ experiments very closely matched what they saw on the molar from Chagyrskaya, which means it’s very likely that the 59,000-year-old tooth was, in fact, the aftermath of an actual Paleolithic medical procedure.

We already knew that Neanderthals, and even earlier hominins, took care of their sick, injured, and disabled; archaeologists have found fossil hominins, dating back hundreds of thousands of years, sporting healed injuries and bone infections that couldn’t have survived without, at the very least, someone bringing them food while they healed. But the Chagyrskaya molar is evidence of skilled medical treatment. It’s the difference between chicken soup and minor surgery.

“Treating a carious tooth is not just feeding or guarding someone. It requires diagnosing the source of pain, selecting an appropriate tool, performing a painful, invasive action, and persisting despite the patient’s discomfort,” said Kolobova. “That is active, targeted medical intervention.”

And—in a frankly impressive success for dental surgery performed in a cave with a sharp rock—the patient went on to use the tooth for years afterward. The molar showed signs of normal long-term wear and tear, which could have only happened if the patient lived to chew another day.

Your dentist’s office was never this scenic.

Credit: Kolobova et al. 2019

What did poor Og go through?

What would this whole experience have been like for the Neanderthal patient? Like modern dentistry—only much, much more so—it would have been deeply unpleasant but better than the alternative. The patient wouldn’t have had the benefit of modern anesthetics, but archaeological traces at other sites suggest Neanderthals knew about medicinal plants like chamomile and yarrow, as well as antiseptics like birch tar. And there are some natural painkillers among the plants of modern Siberia, like white clover, which is also a handy antiseptic.

The Raman spectroscopy didn’t find any residues of plants or resins on the tooth. But if the individual lived for years after their dental appointment, any herbal treatments would probably have worn or washed off, so the absence of residue doesn’t rule anything out. It does, however, leave open the grim possibility that this Neanderthal may have had to white-knuckle it through the procedure.

In Zubova and her colleagues’ experiments, it took about 50 minutes to drill through the enamel and dentin and breach the pulp cavity. The researchers say it could have taken about twice that long if they were working in the cramped confines of a patient’s mouth, with limited visibility and awkward working angles. (Also, Og tends to fidget a lot.)

On the other hand, Neanderthals have thinner dental enamel than Homo sapiens, and there may already have been enough decay in the infected dentin to make it mushy and easier to drill through. So we can safely assume between one and two hours of someone drilling into your tooth with a pointy bit of jasper, with or without any kind of natural painkiller.

“I can say that what struck me, and continues to strike me, is what an incredibly strong-willed person this Neanderthal must have been,” Russian Academy of Sciences paleoanthropologist Lydia Zotkina said. “To me, this is a stunning example of how archaeological evidence can allow us not just to glimpse a single aspect of past people’s lives but to actually understand what these individuals were like—strong and resilient. Now, every time I go to the dentist, I think about that guy.”

It’s likely, according to Zubova and her colleagues, that the patient realized they had no choice. The infection may already have been severe enough to make it impossible to chew or talk, and if left untreated, it could have been fatal. That still happens to people today.

The hole in the chewing surface of this molar was drilled by a Neanderthal with a stone tool.

Credit: Zubova et al. 2026

How Neanderthals invented dentistry

One thing the Chagyrskaya molar proves—which really shouldn’t be surprising given everything else we know about Neanderthals by now—is that the patient and dentist both understood the choice and had the willpower to make it.