Here’s what you’ll learn when you read this story:

• An ancient molar discovered in a Russian cave may offer a surprising example of prehistoric dentistry.
• Experts believe the nearly 60,000-year-old tooth shows signs of being ‘drilled’ with a stone point tool that Neanderthals would have used during that time.
• Researchers believe the tooth offers the world’s oldest evidence of successful dental treatment: an intentional effort to remove a cavity.

A single 59,000-year-old molar discovered in a Russian cave may be the first-ever example of a successful dental procedure in the history of the world: Neanderthals using primitive stone tools to treat an infection. And the patient may have even received some ancient painkillers during the operation.

In a study published in the journal PLOS One, researchers from the Peter the Great Museum of Anthropology and Ethnography wrote that the single tooth—which was found in the Chagyrskaya Cave and had a deep hole in its center—predates the previous oldest example of dental treatment (executed by Homo sapiens) by more than 40,000 years.

“This finding currently represents the world’s oldest evidence of successful dental treatment,” they wrote. “The damage documented on the Neanderthal tooth from Chagyrskaya Cave in Siberia points not only to intentional pulp removal but also to antemortem wear—wear that could only have developed if the individual kept using the tooth while alive.”

The researchers were especially intrigued by the unusual shape of the hole, according to a statement. While computed microtomography showed that the tooth likely did have a severe cavity, the distinctly visible scratches on the sides suggested that the hole was not exclusively the result of natural decay. “Identifying areas of demineralization where remnants of damage were preserved,” the team continued, “further indicated the concavity in the tooth was thanks to purposeful treatment.”

By comparing the ancient tooth with experiments on three human teeth (two Holocene-era teeth and one modern tooth), completed using stone-point tools similar to what Neanderthals would have used 59,000 years ago, the researchers believe they were able to replicate what the ancient tooth was put through. The damaged molar showed evidence of toothpick grooves on the tooth’s side that matched previous archaeological evidence indicating that Neanderthals used stone toothpicks.

The experimental manual drilling allowed the team to compare the microscopic scrapes on the original Neanderthal specimen with those created through different methods of dental material removal. “The findings demonstrate that drilling a carious lesion [also known as a cavity] using a sharp, thin stone tool is entirely effective,” said Lydia Zotkina, “permitting the rapid removal of damaged dental tissue.”

The researchers believe that the cavity-removal procedure would have been painful. But that pain implies that Neanderthals had the cognitive capacity to understand that they could treat the root cause of certain medical issues by eliminating the source of infection. They also had the manual dexterity to pull off the operation. Plus, with previous evidence that Neanderthals used plants for medicinal purposes, there may have been some much-welcomed natural pain relief in the offing.

We have significant evidence that groups of Neanderthals cared for the sick, injured, and elderly among them, so the idea that they would take action to fix a painful tooth wouldn’t be out of character. The team believes that the Neanderthals in the cave “possessed the cognitive capacity to intuit the source of pain, comprehend the feasibility of its elimination, and deliberately elect the most efficacious dental intervention.”