Prehistoric dentistry is far older than 14,000 years as indicated by Villabruna specimen from Late Upper Palaeolithic era. A recent study on 59,000-years-old Neanderthal specimen Chagyrskaya 64 from Middle Paleolithic era has provided evidence of invasive dental caries intervention involving drilling/rotation using lithic perforator and pulp exposure. This reassigns the beginning of prehistoric dentistry to circa 59 Kiloannum (Ka). Significantly, this study indicates that Neanderthals had an evolved cognitive ability as they could think of a causal relationship between pain and tooth decay and make necessary interventions using available tools.
Tooth decay is nearly a universal health problem; most children and nearly every adult suffers from dental caries at some point in their life course. If not attended on time, dental caries may gradually progress to exposure of dentine and pulp giving rise to sensitivity and dental pain which may become debilitating at times. Most of us have some experience of “drilling and filling” of tooth cavities as preventive or therapeutic intervention. But when did this practice begin?
Studies have shown that therapeutic dental filling has a very long history dating back to the prehistoric era. Many Neolithic specimens show evidence of dental interventions. For example, crown of left canine tooth in 6500-year-old human mandible from Slovenia was found to have traces of a filling with beeswax which was likely a palliative intervention to reduce sensitivity.
Neolithic human teeth (about 7000-9000 years old) from the pre-Indus Neolithic Mehrgarh site in Balochistan show evidence of drilling. The molar crowns in this specimen had in vivo dental drilling using flint tips. The purpose is not clear, but the drillings on the crowns were performed while the owners were still alive, perhaps for dental filling to alleviate sensitivity.
Evidence of dental caries intervention is found in older Palaeolithic specimens as well. Villabruna specimen (about 14,000 years old) from Northern Italy is from Late Upper Palaeolithic. The lower right third molar in this specimen was confirmed to have evidence of ante-mortem dental caries intervention, making this the oldest known evidence of dental caries intervention in modern humans. While Villabruna specimen remains the oldest known evidence of dental caries intervention in the modern man (Homo sapiens), a recent study on a Neanderthal specimen suggests that prehistoric dentistry may be far older than thought.
Neanderthal (Homo neanderthalensis) is an extinct human species that disappeared from the face of Earth about 40,000 years ago. They are our closest ancient human relatives through a common ancestor (both Homo sapiens and Homo neanderthalensis evolved from a common ancestor).
The specimen Chagyrskaya 64 is a Neanderthal lower left second molar found in Chagyrskaya Cave in Altai Krai (Siberia, Russia). It is about 59,000 years old from Middle Paleolithic. This Neanderthal molar has a large ante-mortem modification (concavity) on the occlusal surface. A recent study published on 13 May 2026 has concluded that lithic perforator was used to drill the tooth to debride carious tissue and to access the pulp chamber for pulp exposure. The investigators also noted the pronounced toothpick grooving on the same element. The observed modifications on the occlusal surface in this specimen indicate intentional therapeutic intervention on the carious tooth beyond palliative care. All this implies Neanderthals had an evolved cognitive ability including an understanding of causal relationships and fine motor skills to deliver dental caries intervention using tools available at that time.
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References:
- Bernardini F, et al 2012. Beeswax as Dental Filling on a Neolithic Human Tooth. PLoS ONE 7(9): e44904. DOI: https://doi.org/10.1371/journal.pone.0044904
- Coppa, A., et al 2006. Early Neolithic tradition of dentistry. Nature 440, 755–756 (2006). DOI: https://doi.org/10.1038/440755a
- Oxilia, G., et al 2015. Earliest evidence of dental caries manipulation in the Late Upper Palaeolithic. Sci Rep 5, 12150 (2015). DOI: https://doi.org/10.1038/srep12150
- Zubova AV, et al. (2026) Earliest evidence for invasive mitigation of dental caries by Neanderthals. PLoS One 21(5): e0347662. DOI: https://doi.org/10.1371/journal.pone.0347662
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