Neanderthals may have been doing dentistry 59,000 years ago — without anesthetic

About 59,000 years ago, a Neanderthal living in the mountains of Siberia had one hell of a toothache, and seemingly, decided to do something about it.

According to new research, a lower molar discovered in a cave in the foothills of the Altai Mountains shows evidence of dental intervention — a large hole that appears to have been manually drilled with a stone tool to remove decay.

The authors of the study, published in the journal PLOS One, say this is the earliest-known example of invasive dental surgery. And it happened tens of thousands of years before the first recorded evidence of homo sapiens scraping away cavities, adding to the growing body of evidence suggesting the extinct archaic human species was more sophisticated than modern humans have given them credit for.

So how does a Neanderthal with a tooth infection end up in the dentist's chair, so to speak? Anthropologist John Olsen, co-author of the study, says there are two possibilities.

"The one that I cleave to is that this person was in such pain that they reached out to someone else and said, 'I need help,'" Olsen, a professor emeritus at the University of Arizona, told As It Happens host Nil Köksal.

"The second is that this was a self-help process — that whoever had this infected tooth picked up a stone drill, you know, without any mirrors, reached into their mouth and dug around until they felt better."

The second theory, he said, seems unlikely.

"The more we know about Neanderthals, the more we know how social they were and how similar to us they were," he said.

"I wouldn't be digging around in my own mouth if I had an infected tooth."

So who was the helpful cavity remover who heeded the call?

While Olsen doubts there were Neanderthal dentists, per se, he says it's possible the procedure was performed by a medical practitioner of sorts.

University of Toronto paleoanthropologist Bence Viola — who was involved in the discovery of the tooth, but not the subsequent research — says it doesn't appear to be some fly-by-night operation.

"It looks like it's done quite nicely. So my assumption would be that whoever did this had experience in doing this," he said.

The tooth in question belonged to an adult of unknown gender. It was unearthed in Russia at Chagyrskaya Cave, a rich site of Neanderthal fossils.

The researchers examined the fossil under high-power magnification and say the marks on the tooth, combined with the shape of the hole, indicate it was deliberate modification and not accidental damage or normal wear-and-tear.

To further test the theory, they performed experiments on three modern human teeth. They were able to recreate a hole with the same shape and microscopic grooves by drilling into the molar with a stone tool similar to ones found inside Chagyrskaya Cave.

Until now, the oldest known evidence of dental surgery was a Homo sapiens tooth found in Italy dating to about 14,000 years ago, which had a cavity that was scraped and cleaned with a stone tool.

"It proves Neanderthals possessed sophisticated cognitive abilities, including planning, precise motor skills and deliberate medical strategy, challenging the outdated view that such complex behaviour was exclusive to modern humans," said Kseniya Kolobova of the Russian Academy of Sciences, the study's senior author.

"The procedure required diagnosing the source of pain, understanding that removing decayed tissue could bring relief, deliberately selecting an appropriate stone tool and executing precise drilling with controlled finger movements."

Simon Fraser University archeologist Mark Collard, who was not involved in the study, says it's impossible to say with any certainty that this was a dental procedure, but the authors "make a decent case."

"The study potentially adds an exciting, early instance of health care to a small but growing sample," said Collard, also the Canada Research Chair in Human Evolutionary Studies, in an email.

Neanderthals, our sister species, died off roughly 40,000 years ago, though most people today carry a small amount of their DNA due to interbreeding with Homo sapiens.

In pop culture, Neanderthals have often been depicted as oafish and stupid, and those depictions have shifted with changing socio-political views .

But in recent years, several studies have emerged challenging that narrative, showing that Neanderthals created art, crafted tools, hunted with spears, wore ornamental jewelry, held funerals for their dead and cared for their sick.

For Olsen, the most interesting thing about the tooth study is not what it says about Neanderthals' possible medical prowess — but rather their communication skills.

The procedure, done without the aid of modern anesthetic, would have been excruciatingly painful, he said. That means any patient who submitted to it must have been made to understand that enduring short-term pain would result in long-term gain.

"How do you communicate that? I mean, that's a really complicated idea given our stereotypical view of Neanderthals as brutish beasts who could barely grunt out, you know, 'Need food,' or something," he said.