A decade ago in southern Siberia’s Chagyrskaya Cave, archaeologists unearthed a 59,000-year-old Neanderthal molar with a curious, deep hole. A study published this month in the journal PLOS One proposed that the molar’s owner had suffered a severe toothache, prompting the patient, or a brave peer, to attempt an intervention.
The tooth’s hollow had been scooped out by a stone drill rather than by natural decay or wear, researchers at the Russian Academy of Sciences concluded. They replicated the bore marks in three modern human molars with fine-pointed drills fashioned from jasper, a tough quartz found in the area around the cave and used to make other tools discovered at the site.
The findings indicated that the prehistoric patient underwent a deliberate Stone Age root canal, a discovery that pushes back the earliest evidence of intentional dentistry by more than 40,000 years.
Treating the cavity was an act of neurological and mechanical sophistication, requiring the ancient hominins to diagnose the source of pain, select the appropriate stone tool and employ remarkable dexterity to scrape down to the pulp, the tooth’s inner tissue.
Enduring such a torturous, anesthesia-free root canal required staggering willpower. Yet the tooth shows continued wear after the drilling took place, meaning the patient survived and kept using the molar.
The tooth was dug up by the archaeologist Ksenia Kolobova, who collaborated on the study with Lydia Zotkina, whose specialty is stone tool production and usage, and the dental anthropologist Alisa Zubova. They were joined by John Olsen, an emeritus professor of anthropology at the University of Arizona.
This conversation with Dr. Olsen has been condensed and edited for clarity.
The final steps in a modern root canal involve filling and sealing the hollowed-out root system, typically followed by a permanent dental crown to protect the brittle tooth from fracturing. What material might a Neanderthal dentist have used to pack the hole?
The most likely fillings would have been beeswax, pine pitch, birch tar or some other herbal reduction yielding a paste that could have been applied as needed and would presumably have had analgesic if not antiseptic properties, in addition to simply keeping the hole filled.
Does the cavity show signs of having been filled?
As far as we can tell, none at all. But given the strong likelihood that such a filling would have been some sort of organic matter like birch tar, it’s possible that after lying around the cave for 60,000 years, so much of it had been leached away that it is no longer detectable, at least not with the technology we have brought to bear.
The study proposes that a dental instrument made of jasper was likely used to ream the tooth. How would that have worked?
We have two different artifact types that could have been used. One is called a drill by archaeologists, because it presumably had that function in life. The other, a beak, is generally considered a simpler tool, made of a stone flake that comes to a sharp point.
Both would have been held between the thumb and the forefinger in a pinch grip, then twisted and rotated continuously against the surface of the infected tooth.
Recreating the procedure on modern human teeth showed the process would have taken around 35 to 50 minutes of continuous, high-pressure drilling to penetrate the dentin and expose the pulp chamber.
These days, the living pulp, which contains nerves and blood vessels, is completely removed from inside the tooth, then the empty pulp chamber and root canals are cleaned and filled to seal them and prevent future infections. Typically, the post-procedure discomfort fades within three to five days.
Going back 60,000 years or even 2,000 years, there were really no other alternatives other than trying to get as much of that rotted material out of the tooth as possible.
Why not just knock out the tooth?
Possibly that happened from time to time, but there’s no evidence of that on this particular tooth. One of the things we want to be careful of is extrapolating too far and saying, “This is the way it was done.”
Evidence from dental plaque on some Neanderthal fossils has revealed traces of natural antibiotics like penicillin mold and painkillers, such as poplar bark. Does this suggest that individuals intentionally swallowed these remedies to alleviate pain?
The Neanderthals, bless their hearts, were apparently very adept at what we would consider invasive medicine, and I’m talking about the amputation of an arm in one case. They also seem to have had a deep interest in herbal medicine and surrounded themselves with various kinds of plants that could have been used for medication.
None of that, to my knowledge, could have been used as anything more than an anesthetic, very local in nature, and an antiseptic after the fact. So I think no matter how you cut it, a root canal would have been gruesomely painful.
Was the Neanderthal enduring the toothache simply self-medicating, or was this our earliest example of compassionate caregiving?
Given the Neanderthals’ apparent interest in medicinal herbs and given their toughness, it seems more logical to me that a second person, and potentially a third stabilizing the patient’s head, would have been involved.
So, maybe a dentist and a dental assistant?
Essentially. I don’t want to go too far down that road, because you enter into the realm of speculative silliness. But yes, I think that it would not have taken a giant intuitive leap for a second person to say: “It’s a second lower molar in the back, and it’s going to be hard to get in there. I can do a better job than you because I can stand at an angle and apply serious leverage as I’m twisting this tool. Let’s have Aunt Sue hold your head in her lap while I actually do the work.”
Neanderthals may have been quite sophisticated at speaking with gestures, and they were probably more verbally adept than we give them credit for. I mean, they may not have been discussing the finer points of Buddhist philosophy….
I’ve read that Neanderthal teeth generally lacked cavities not because of a trendy paleo diet, but because their sugar-free foraging left oral bacteria with nothing to ferment.
If you looked at all the human teeth that have ever been excavated from an archaeological context, you would notice a dramatic, almost overnight difference between pre-agriculture and post-agriculture.
Most of our domesticated plants are high in carbohydrates and other sugars. And we eat a lot of them. And in the past, we processed them in grinding stones. And in the course of that, we chewed on grit that was like grinding your teeth and then rubbing sugar on it.
What effect has that had on mortality rates?
Tooth decay was a leading cause of death hundreds to thousands of years ago, peaking roughly in the 1600s to 1800s. Before the advent of antibiotics, bacteria from the mouth could travel to the heart and colonize damaged heart valves, causing them to become severely inflamed.
If the infection progressed to endocarditis or severe sepsis, there was a good chance it would kill you. The fact that there is scant evidence of dental cavities killing Neanderthals or anyone else prior to about 12,000 years ago, maybe even earlier than that, says a lot about the role of diet.
Has the tooth research increased your admiration for Neanderthals?
Absolutely. These were tough men and women coping with high-stress environments and doing it really well for hundreds of thousands of years.
Neanderthals recognized that every time they went out hunting, there was some seriously high statistical chance they were never coming home. And after a certain number of generations, that psychology becomes ingrained in a way that maybe made things like having pulp dug out of your tooth not a very big deal.
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