Neanderthals used stone drills to treat cavities almost 60,000 years ago in what is the earliest known evidence of dental treatment.

The single molar, which was unearthed in a cave in southern Siberia, features a deep hole that appears to have been created using a sharp, thin stone tool during the lifetime of the tooth’s owner.

While the prospect of stone age root canal treatment may be excruciating to even contemplate, archaeologists say the discovery provides remarkable insights into Neanderthals’ advanced behaviours – and possibly their gritty disposition.

Dr Kseniya Kolobova, an archaeologist at the Siberian branch of the Russian Academy of Sciences in Novosibirsk, said: “This discovery powerfully reinforces the now well-supported view that Neanderthals were not the brutish, inferior cousins of outdated stereotypes but a sophisticated human population with complex cognitive and cultural capacities. [It] adds an entirely new dimension – invasive medical treatment – to the growing list of advanced Neanderthal behaviours.”

This is the first time dental drilling has been demonstrated outside of Homo sapiens, and it is the oldest example of such behaviour by more than 40,000 years.

A dental professor, who reviewed images of the tooth but was not part of the research, rated the Neanderthal’s work as “a decent job”.

“If I was marking this for a dental student, I wouldn’t give it an A, but given the circumstances it’s pretty impressive,” said Justin Durham, a professor of orofacial pain at Newcastle University and the British Dental Association’s chief scientific adviser.

The smoothed edges of the drilled cavity, and wear patterns inside it, suggested the individual survived and continued to chew with the tooth for some time after the procedure.

The tooth, which has been dated to be 59,000 years old, was found in Chagyrskaya, where the remains of Neanderthals and thousands of stone tools have been excavated. The lower molar features a deep hole in the centre of the tooth extending into the pulp cavity. Microscopic X-ray imaging revealed changes in mineralisation that indicated severe tooth decay.

The researchers conducted experiments on three modern human teeth to demonstrate that a hole of the same shape and same patterns of microscopic grooves could be created by manually rotating a narrow, elongated tool made from local jasper, between two fingers. Penetrating the dentin using this approach took between 35 and 50 minutes of continuous work, according to the research published in the journal PLOS One.

“It would have been excruciating,” said Kolobova.

Durham said the intervention, which he described as “the beginnings of a root canal treatment”, was likely to have relieved pain in the short term.

“The tooth is a closed box. So the pressure [that builds up during an infection] is what causes the intense, painful, pounding, pulsing toothache that people are familiar with,” he said. “If you put a big hole in the tooth like this Neanderthal dentist did, it would relieve that pressure.”

“We have to use diamond-tipped burrs running at greater than 40,000 revolutions a minute to get through the outer surface of the tooth in modern-day dentistry,” Durham added. “So this is quite a phenomenal achievement, which is why I take my hat off to the Neanderthal who did it. It really does demonstrate high-level thinking and high-level skills as far as I’m concerned.”

The patient appeared to survive for some time, but, left unfilled, the tooth would have been vulnerable to chronic infection.

Previous evidence of Neanderthals caring for the sick and vulnerable group members includes the discovery of an adult man with a withered arm and deformities in both legs and a child with Down’s syndrome who survived until at least the age of six. The latest discovery reveals not only compassion, but an impressive level of self-control by the patient.

“What struck me, and continues to strike me, is what an incredibly strong-willed person this Neanderthal must have been,” said Dr Lydia Zotkina, an archaeologist at the Russian Academy of Sciences and co-author. “They must have surely understood that although the pain of the procedure was greater than the pain of the inflammation, it was only temporary and had to be endured.”

“Now, every time I go to the dentist, I think about that guy,” she added.