Prehistoric dental treatment documented at a burial site in northern Italy

Story: 12000 B.C.E.  |  Last updated: January 6, 0001

A young man buried in the foothills of the Italian Alps around 12,000 B.C.E. had a serious problem with one of his back teeth — and someone tried to do something about it. The evidence, preserved in a single lower molar for more than 14,000 years, points to the oldest known attempt at treating a dental cavity in the entire human fossil record.

Key findings

• Prehistoric dental treatment: The Villabruna specimen, a young male recovered from Riparo Villabruna in Belluno, northern Italy, shows deliberate manipulation of a large cavity in his lower right third molar using pointed flint tools — predating all previously known dental interventions by thousands of years.
• Flint tool evidence: Scanning electron microscopy revealed V-shaped striations and parallel micro-scratches inside the cavity consistent with scratching and levering actions — identical in character to cut marks found on bones — and confirmed to have occurred before death.
• Caries intervention timeline: Prior to this discovery, the earliest unambiguous evidence of true caries treatment came from the Neolithic period, roughly 9,000 years ago in Pakistan; the Villabruna find pushes that timeline back to the Late Upper Palaeolithic, when humans were still predominantly hunter-gatherers.

A tooth, a cavity, and a decision

The Villabruna individual was around 25 years old when he died. He was buried in an Epigravettian deposit — a cultural layer associated with Late Upper Palaeolithic communities in southern Europe — and his remains were excavated in 1988. Radiocarbon dating places his life at approximately 14,160 to 13,820 calibrated years before present, or roughly 12,210 to 11,870 B.C.E.

His lower right third molar carried a large occlusal cavity — nearly six millimeters across — containing four distinct carious lesions. The deepest of these had penetrated into the dentine but had not yet reached the pulp chamber. Anyone who has experienced an untreated cavity near that stage will understand the likely discomfort.

Researchers at the University of Trieste and collaborating institutions analyzed the tooth using scanning electron microscopy and micro-CT imaging, then performed experimental replication in the lab with flint tools to confirm what the marks meant. The striations inside the cavity matched what flint produces when used with a scratching and levering motion — not the signatures of chewing, wear from an opposing tooth, or post-mortem damage. Occlusal fingerprint analysis further ruled out the possibility that normal biting movements caused the enamel chipping on the cavity walls.

The conclusion: someone used a pointed stone tool to work inside that cavity, almost certainly to relieve pain or remove decayed tissue. The study was published in Scientific Reports.

Why this moment matters in human evolution

Before this discovery, scholarly consensus held that true dental treatment — deliberate intervention to address a carious lesion — began in the Neolithic, when farming diets rich in fermentable carbohydrates drove sharp increases in tooth decay. A beeswax filling from Slovenia dated to around 6,500 years ago and bow-drill perforations in molars from a Pakistani graveyard around 9,000 years ago were the oldest known examples.

The Villabruna find is roughly 2,000 to 3,000 years older than those cases. More significantly, it comes from a hunter-gatherer context. Dental caries are generally less common among hunter-gatherers than among early farmers, but less common is not the same as absent. This individual had a significant cavity, and it was treated.

What makes the intervention especially interesting is its method. Rather than drilling — the technique associated with Neolithic dentistry — the Villabruna practitioner appears to have adapted toothpicking, a behavior documented across human evolution from early Homo through Neanderthals. Toothpick use for interproximal cleaning left grooves between teeth throughout the Palaeolithic. Here, that same basic manual skill was redirected toward a new purpose: working inside a cavity to address disease. The researchers describe this as an adaptation of toothpicking for levering and scratching rather than an independent invention of drilling.

That framing carries weight. It suggests that the cognitive and behavioral toolkit for treating dental problems may have existed long before farming made caries a widespread public health issue. The capacity for care was already there; the urgent need simply arrived later.

Lasting impact

The Villabruna discovery changes the baseline for when deliberate medical intervention — not just hygiene, but treatment of a specific disease — appears in the human record. It implies that at least some Palaeolithic communities recognized the connection between a painful tooth condition and the possibility of doing something about it.

That recognition is not a small thing. Identifying a problem, forming an intention to address it, and using a tool to execute that intention across a difficult and sensitive anatomy requires a chain of reasoning that goes beyond instinct. It is, in a modest but meaningful sense, medicine.

The finding also opens new lines of research. If one Late Upper Palaeolithic burial in northern Italy shows this, how many other specimens in existing collections carry similar marks that have not yet been analyzed with sufficient resolution? Paleoanthropological research increasingly applies high-resolution imaging to fossils originally studied decades ago, and revisions to the record are becoming more common. The story of early human medicine may be considerably richer than the current fossil record suggests.

Downstream, this evidence connects to a broader picture of Palaeolithic cognitive sophistication — the same communities producing figurative art, personal ornamentation, and long-distance exchange networks. Dental care, even in its most rudimentary form, fits within that picture rather than standing apart from it.

Blindspots and limits

This is a single specimen. The evidence is robust for this individual, but one case cannot establish how widespread dental treatment was among Late Upper Palaeolithic populations, how frequently it was attempted, or whether it was practiced across different regions. The striations confirm tool use inside the cavity but cannot confirm the intent with certainty — pain relief and an incidental exploration of the cavity are both consistent with the marks, even if deliberate caries intervention is the most parsimonious interpretation. The identity of whoever performed the procedure, the social context of the treatment, and whether any practical knowledge was transmitted to others are all beyond what the fossil record can currently tell us. It is also worth noting that the caries were not fully removed — whatever the intervention achieved, it did not resolve the underlying disease.

Read more

For more on this story, see: Scientific Reports — Earliest evidence of dental caries manipulation in the Late Upper Palaeolithic

For more from Good News for Humankind, see:

• Global suicide rate has fallen by 40% since 1995
• Alzheimer’s risk cut in half by drug in landmark prevention trial
• The Good News for Humankind archive on prehistory

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