Neanderthals practiced a surprisingly advanced form of dentistry, detecting tooth decay and removing it with stone drills, according to recent Russian research at the Chagyrskaya Cave site, which reframes how advanced this archaic human species truly was.
A recent paper published in PLOS One by researchers from the Russian Academy of Sciences and the Uzbekistan Academy of Sciences builds on earlier work showcasing Neanderthal dental knowledge, including tooth picks and the use of medicinal plants, by revealing an even more invasive form of prehistoric dentistry.
At the center of the discovery is a single Neanderthal molar sourced from Russia’s Chagyrskaya Cave, featuring a deep, artificial hole reaching through to the pulp cavity.
Investigating a Neanderthal Tooth
Researchers compared the Neanderthal molar discovered at Chagyrskaya Cave with modern human teeth, experimenting with a stone drill to recreate the hole. The team had noticed that the hole in the Neanderthal tooth and the grooves on the molar’s side appeared to be rare examples of attempts to mitigate carious lesions, a type of tooth decay caused by acid-producing bacteria living in plaque. They sought to determine if their modern attempts to recreate the hole would produce similar microscopic grooves in the modern teeth.
One of the most interesting elements of the work was the identification of Neanderthals’ ability to understand medical issues in the long term and identify the root causes of specific maladies, as well as their level of fine manual dexterity. While the tooth infection would have been painful, the drilling would also have been excruciating without anesthesia. Yet despite this tremendous discomfort, they understood the specific cause and how to permanently remove it.
Moving the Timeline
Previously, the earliest known evidence of human dentistry known to scientists was the Villabruna specimen, discovered at Ripari Villabruna in northern Italy, according to Kseniya Kolobova, the recent study’s co-author, in an email to The Debrief. “Before the Chagyrskaya discovery, this was considered the oldest evidence of dental cavity treatment. The skeleton of a young man who died around 14,000 years ago was found there in 1988.”
“In 2015, researchers led by Stefano Benazzi published a study showing that his lower right third molar had a large cavity that was not just decay—it contained distinctive V-shaped striations and parallel microscratches that experiments confirmed were made by a pointed flint tool scraping and levering out infected tissue,” Kolobova added. “The enamel around the cavity was polished from wear, proving the individual survived the procedure.”
With the discovery of the Chagyrskaya tooth, the timeline altered again, now pushing back the earliest evidence of dentistry by about 45,000 years. Not only that, but the revised history now also includes another human species.
Another recent discovery at Riparo Fredian, a site near Garfagnana in Tuscany, is reportedly the next-oldest example at roughly 13,000 years old, and demonstrates successful tooth filling with a mixture of bitumen, fiber, and hair.
An Unusual Malady
The researchers pinpointed a likely initial cause of the tooth pain that would have necessitated this precocious ancient dentistry: a carious lesion.
“The evidence strongly points to a caries lesion as the initial cause of pain,” Kolobova said. “The micro-CT scans clearly show extensive demineralization of the dentin surrounding the drilled concavity, consistent with a deep carious lesion that had reached both the inner and outer layers. Additionally, a second carious focus was identified around the toothpick groove on the distal side of the crown, indicating the tooth was affected by decay in multiple locations.”
While carious lesions are a relatively common problem in modern dentistry, they would have been far less common in Neanderthals, thanks to their carnivorous diet. Carbohydrates allow cariogenic bacteria to ferment, which eats away at the enamel and dentin. Tartar also stems from a diet high in starches and agricultural products. This means that the researchers identifying two carious lesions in this small population in Chagyrskaya Cave is highly unusual, yet they say this is not enough evidence to suspect the population was living an atypical lifestyle.
An Expanding View of Neanderthals
The new findings fit into a broader rethinking of the extent of Neanderthal advancement, evidencing abilities beyond previous expectations. Human thumbs allow us to grip objects and manipulate our environments in ways beyond the capabilities of other lifeforms, yet earlier research concluded that Neanderthals were limited in making use of this evolutionary gift by a lack of fine motor skills compared to Homo sapiens.
With the discovery of advanced dental work, researchers have what may be the best evidence yet that the coordination gap may have been far less than previously assumed.
“For much of the 20th century, it was commonly assumed that Neanderthals lacked the fine motor skills of modern humans,” Kolobova explained. “Their robust, broad-fingered hands were thought to be adapted primarily for powerful grips rather than the precise finger control needed for delicate tasks. However, this perspective has been overturned by multiple lines of evidence.”
“Directly relevant to Chagyrskaya, researchers studying bone retouchers from the same cave had already shown these Neanderthals habitually used a delicate three-finger pinch grip,” Kolobova concludes.
“The dental drilling procedure now provides the most striking confirmation yet,” he adds, noting that it “directly demonstrates the application of such precision capabilities in a high-stakes medical context, moving the debate from anatomical theory to concrete evidence of a controlled, delicate manual task.”
The paper, “Earliest Evidence for Invasive Mitigation of Dental Caries by Neanderthals,” appeared in PLOS One on May 13, 2026.
Ryan Whalen covers science and technology for The Debrief. He holds an MA in History and a Master of Library and Information Science with a certificate in Data Science. He can be contacted at ryan@thedebrief.org, and follow him on Twitter @mdntwvlf.