Archaeological Evidence Suggests Neanderthals Practiced Basic Dental Care

The Tooth That Changed Everything

In 2016, archaeologists working in Chagyrskaya Cave in southwestern Siberia's Altai Mountains pulled a worn molar from sediment layers dating to roughly 59,000 years ago. For years, the tooth sat among thousands of Neanderthal bone fragments catalogued from the site. Then a team led by dental anthropologist Alisa Zubova of the Peter the Great Museum of Anthropology and Ethnography at the Russian Academy of Sciences took a closer look — and found something no one expected [1].

The molar, designated Chagyrskaya 64, contained a large concavity on its biting surface that extended down to the pulp chamber floor. Measuring 4.2mm long, 2.8mm wide, and 2.6mm deep, the hole was composed of three interconnected depressions bearing microscopic radial grooves consistent with a rotating or drilling motion from a hard, pointed stone tool [2]. In a study published May 13, 2026, in PLOS One, Zubova and eleven co-authors — including archaeologist John Olsen of the University of Arizona and Ksenia Kolobova of the Institute of Archaeology and Ethnography at the Siberian Branch of the Russian Academy of Sciences — presented their case that this was the earliest known invasive dental treatment by any hominin species [1][2].

Olsen described the procedure bluntly: "Basically a root canal," performed by "a stone tool handled by a Neanderthal between the thumb and the forefinger" [3].

If the interpretation holds, it pushes back the history of dentistry by more than 40,000 years. The previous oldest evidence of dental intervention came from Upper Paleolithic Homo sapiens sites dating to roughly 14,000 years ago [4].

How They Tested the Claim

The researchers did not rely on observation alone. Using ancient stone-knapping techniques, they fashioned small pointed tools from jasper — a material found in abundance around Chagyrskaya Cave — and then tested whether hand-twisted drilling with these implements could produce the same patterns seen in the ancient molar [2].

The experimental protocol was rigorous. The team used traceological microscopy at magnifications ranging from 8× to 500×, scanning electron microscopy, micro-computed tomography, and Raman spectroscopy to compare the fossil's surface features with those produced experimentally on three modern human teeth [2]. Lydia Zotkina, a traceologist at the Institute of Archaeology and Ethnography, even donated one of her own extracted wisdom teeth for the experiments [5].

The results were striking: the experimental holes closely matched the fossil's concavity in shape, size, and microscopic groove patterns. In each case, the researcher was able to remove the majority of the dental tissue using manual drilling in less than an hour [3][5].

Crucially, the pit walls of the ancient tooth showed smooth, polished surfaces — evidence that the tooth remained in use after the procedure, suggesting the individual survived the intervention and continued to chew with the treated molar [5].

Not Just One Tooth: A Map of Neanderthal Dental Evidence

The Chagyrskaya molar is the most dramatic piece of evidence, but it sits within a much larger body of findings from sites spanning Europe and Central Asia over nearly 100,000 years.

Source: Compiled from multiple archaeological studies

Data as of May 14, 2026CSV

Krapina, Croatia (~130,000 years ago): In 1987, David Frayer — then at the University of Kansas — first documented artificial grooves along the cemento-enamel junction of 14 teeth from ten different Neanderthal individuals at this site. The grooves displayed consistent morphological features: trough-like appearance, striations and polishing in the channel, and ridges of reactive cementum (new bone growth) bordering the groove [6]. In a 2017 follow-up study, Frayer and colleagues including Davorka Radovčić of the Croatian Natural History Museum examined "Krapina Dental Person 20" — four mandibular teeth showing six toothpick grooves, dentin scratches, antemortem enamel fractures, and evidence of deliberate tooth displacement, all consistent with self-treatment of eruption abnormalities [7].

Cova Foradà, Spain (~50,000 years ago): A Neanderthal maxilla (upper jaw) designated CF-1 showed two interproximal grooves on adjacent teeth, combined with heavy periodontal disease and alveolar bone loss of four to eight millimeters. In a 2013 PLOS One study, Marina Lozano and colleagues argued this represented "one of the first examples of palliative treatment with toothpicks" — not just casual food removal but a deliberate response to pain from gum disease [8].

El Sidrón, Spain (~49,000 years ago): Dental calculus from this site yielded some of the most remarkable findings in the entire field, published in Nature in 2017 by Laura Weyrich of the University of Adelaide's Australian Centre for Ancient DNA and an international team [9].

Spy Cave, Belgium (~36,000 years ago): Calculus from Neanderthals at this site provided dietary contrast data in the same Weyrich et al. study, showing a meat-heavy diet including rhinoceros and wild sheep [9].

What Dental Calculus Reveals About Diet and Medicine

Dental calculus — the mineralized plaque that accumulates on teeth over a lifetime — has become one of the most valuable archives in paleoanthropology. When Weyrich and colleagues sequenced ancient DNA from calculus of five Neanderthal individuals across Europe, they found stark dietary differences: the Belgian Spy Neanderthal ate large game, while the Spanish El Sidrón individuals consumed pine nuts, moss, and mushrooms [9].

But the most striking finding involved an El Sidrón individual who had a visible dental abscess and carried the gastrointestinal pathogen Enterocytozoon bieneusi. This individual's calculus contained DNA from poplar bark — which contains salicin, the chemical precursor to aspirin's active ingredient, salicylic acid — and from the mold Penicillium, which naturally produces antibiotic compounds [9][10].

"Apparently, Neanderthals possessed a good knowledge of medicinal plants and their various anti-inflammatory and pain-relieving properties, and seem to be self-medicating," said Alan Cooper, then director of the Adelaide ancient DNA center, at the time of the study's publication [10].

The calculus record also yielded the oldest draft microbial genome ever generated: Methanobrevibacter oralis, an archaeal commensal dating to approximately 48,000 years ago [9]. A more recent database project called SMILE (Systematic Microbiome Intelligence for Lost Ecosystems) has since expanded this work to encompass 1,414 archaeological specimens spanning 102,000 years, tracking changes in oral microbiome composition from Neanderthal cave sites through medieval European populations [11].

How Neanderthal Teeth Compare to Early Humans

Dental disease was rare among all pre-agricultural hominins, but comparisons between Neanderthals and contemporary Homo sapiens reveal meaningful differences in tooth wear rather than cavity rates.

Source: Compiled from paleopathological literature

Data as of May 14, 2026CSV

Caries prevalence among Neanderthals was extremely low — fewer than ten confirmed cases have been identified across all recovered Neanderthal teeth [4]. Upper Paleolithic Homo sapiens show only slightly higher rates, estimated around 3% of teeth affected. The real inflection point came with the Neolithic agricultural transition, when carbohydrate-rich diets caused caries rates to spike above 10% — a pattern that accelerated through the medieval period and into the modern era [4][12].

Where Neanderthals stood apart was in the severity and distribution of tooth wear. Research published in the Journal of Human Evolution found that Neanderthal anterior teeth wore more rapidly than those of Upper Paleolithic modern humans, with a characteristic pattern of wear more evenly distributed across the front teeth [13]. This has been attributed to the "anterior dental loading hypothesis" — the idea that Neanderthals routinely used their front teeth as a third hand, gripping hides, sinew, or other materials during processing tasks [13][14].

This raises a central question for interpreting the archaeological record: how much of the wear, grooves, and damage visible on Neanderthal teeth reflects intentional dental care, and how much is simply the consequence of hard use?

The Counterargument: Grooves Without Hygiene

The most methodologically rigorous challenge to the "Neanderthal dental hygiene" interpretation came from Ian Towle and Luca Fiorenza of Monash University. In a study published in the American Journal of Biological Anthropology, they examined more than 500 teeth from 27 primate species — all from wild populations with no access to tools [15].

Approximately 4% of individuals displayed lesions that closely resembled the "toothpick grooves" traditionally attributed to tool use in fossil hominins, complete with fine parallel scratches and tapering shapes [15]. Natural chewing, abrasive foods, swallowed grit, and specialized behaviors like stripping vegetation with the teeth could all produce similar patterns, the researchers argued.

"Grooves that resemble 'toothpick' marks don't necessarily prove tool use," the study concluded, urging researchers to apply more caution before interpreting every fossil groove as evidence of deliberate dental hygiene [15].

For the Chagyrskaya molar specifically, bioarchaeologist Rachel Kalisher of UC San Diego acknowledged the "beautiful data" in the 2026 study but cautioned that the evidence may not constitute a "smoking gun" for intentional treatment, noting that environmental wear could offer an alternative explanation [3].

The broader point is that Neanderthals used their teeth as tools far more intensively than modern populations. Research on both Neanderthal and early modern human anterior teeth found similar wear patterns, suggesting heavy paramasticatory use — holding, pulling, and processing materials with the teeth — was common across Late Pleistocene hominins, not unique to Neanderthals [14][16].

Shifting Consensus: From Brutes to Near-Equals

The debate over Neanderthal dental care is inseparable from a larger, decades-long reckoning in paleoanthropology about Neanderthal cognitive abilities.

Source: OpenAlex

Data as of Jan 1, 2026CSV

Through the mid-1990s, the dominant view held that Neanderthals were cognitively inferior to Homo sapiens — capable of basic tool manufacture but lacking symbolic thought, language, and the capacity for planning and healthcare that defined behavioral modernity. That consensus has eroded steadily since.

Key milestones include: pigmented shells used as jewelry in Spain, dated to at least 115,000 years ago; cave paintings in Iberia confirmed to predate modern human arrival in Europe; Mousterian stone tools requiring multi-step planning; burials with apparent grave goods; and evidence of long-term care for severely injured group members [17][18].

Penny Spikins, professor of archaeology at the University of York, has been among the most prominent researchers arguing that Neanderthal healthcare was "widespread" and represented "a compassionate and knowledgeable response to injury and illness" rather than calculated reciprocal exchange [18]. Her 2018 study in World Archaeology documented numerous cases of Neanderthals surviving serious injuries — broken bones, lost teeth, degenerative joint disease — that would have required sustained care from others [18].

Commenting on the Chagyrskaya finding, Spikins noted that the procedure demonstrated a capacity to "identify pain sources and willingness to endure short-term suffering for long-term relief" — cognitive abilities well beyond instinct [5].

Andrey Krivoshapkin, a paleoarchaeologist at the Russian Academy of Sciences' Institute of Archaeology and Ethnography and a co-author of the 2026 study, put it more directly: "This moves beyond simple hygiene into the realm of active medical treatment. That is not instinct" [5].

A 2025 paper in Proceedings of the National Academy of Sciences pushed back against remaining assumptions about cognitive gaps. The authors argued that differences between modern human and Neanderthal brains — as estimated from endocranial reconstructions — "do not meaningfully exceed those among different modern human populations," and that the implied average cognitive differences were "extremely small, with extensive population overlap" [17].

Are We Overcorrecting?

Not everyone is comfortable with the pace of reinterpretation. Some researchers worry that the field is projecting modern human cognitive frameworks onto ambiguous evidence.

The Chagyrskaya study rests on a single molar. The El Sidrón self-medication evidence relies on the co-occurrence of plant DNA and pathogen DNA in calculus — correlation that does not prove the Neanderthal intentionally sought out poplar bark for its analgesic properties. The Krapina toothpick grooves, while found across ten individuals, could reflect habitual behaviors unrelated to hygiene, as the Towle and Fiorenza primate study suggests [15].

David Frayer, whose work on Krapina teeth spans nearly four decades, has acknowledged the interpretive challenges but maintains that the convergence of multiple lines of evidence — grooves, reactive bone growth, association with pathology — makes incidental explanations progressively less plausible [6][7].

The funding landscape also warrants scrutiny. The Chagyrskaya study was supported by the Russian Academy of Sciences, with contributions from the University of Arizona. The broader "cognitive modernity" debate has attracted significant institutional investment on multiple sides, and researchers whose careers are built on demonstrating Neanderthal sophistication have professional incentives to interpret ambiguous evidence favorably — a dynamic that applies equally to those invested in maintaining cognitive distinctions [2][17].

What a Single Tooth Can and Cannot Prove

The Chagyrskaya molar, if the drilling interpretation is correct, demonstrates that at least one Neanderthal group in Siberia 59,000 years ago possessed the knowledge to identify a dental infection, the skill to fashion and manipulate a stone drill, and the social context — someone had to hold still while another individual drilled into a live tooth — to carry out what amounted to a surgical procedure [2][3].

Combined with the Krapina toothpick evidence dating back 130,000 years, the Cova Foradà palliative care evidence, and the El Sidrón self-medication data, the overall picture is of a species that understood pain, attempted to treat it, and passed relevant knowledge through their communities [6][7][8][9].

What it cannot prove is how widespread these practices were, whether they represented cultural traditions transmitted across generations, or whether they arose independently in isolated populations. Fewer than ten dental caries cases have been identified across all known Neanderthal remains, so the sample size for studying treatment responses remains vanishingly small [4].

The research publication trend tells its own story. Academic output on "Neanderthal dental" topics has grown from roughly 100 papers per year in 2011 to a peak of 397 in 2023, reflecting sustained and growing scientific interest in these questions [19].

What remains clear is that the old caricature — the slack-jawed cave dweller incapable of foresight or care — has been replaced by something more complex and less certain. The evidence from Neanderthal teeth, both what it shows and what it leaves ambiguous, reflects a species closer to us than most twentieth-century scientists imagined, and whose full cognitive range remains, tooth by tooth, still being excavated.