The dawn of dentistry in the late upper Paleolithic: An early case of pathological intervention at Riparo Fredian

Gregorio Oxilia, Flavia Fiorillo, Francesco Boschin, Elisabetta Boaretto, Salvatore A. Apicella, Chiara Matteucci, Daniele Panetta, Rossella Pistocchi, Franca Guerrini, Cristiana Margherita, Massimo Andretta, Rita Sorrentino, Giovanni Boschian, Simona Arrighi, Irene Dori, Giuseppe Mancuso, Jacopo Crezzini, Alessandro Riga, Maria C. Serrangeli, Antonino VazzanaPiero A. Salvadori, Mariangela Vandini, Carlo Tozzi, Adriana Moroni, Robin N.M. Feeney, John C. Willman, Jacopo Moggi-Cecchi, Stefano Benazzi

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Objectives: Early evidence for the treatment of dental pathology is found primarily among food-producing societies associated with high levels of oral pathology. However, some Late Pleistocene hunter-gatherers show extensive oral pathology, suggesting that experimentation with therapeutic dental interventions may have greater antiquity. Here, we report the second earliest probable evidence for dentistry in a Late Upper Paleolithic hunter-gatherer recovered from Riparo Fredian (Tuscany, Italy). Materials and Methods: The Fredian 5 human consists of an associated maxillary anterior dentition with antemortem exposure of both upper first incisor (I1) pulp chambers. The pulp chambers present probable antemortem modifications that warrant in-depth analyses and direct dating. Scanning electron microscopy, microCT and residue analyses were used to investigate the purported modifications of external and internal surfaces of each I1. Results: The direct date places Fredian 5 between 13,000 and 12,740 calendar years ago. Both pulp chambers were circumferentially enlarged prior to the death of this individual. Occlusal dentine flaking on the margin of the cavities and striations on their internal aspects suggest anthropic manipulation. Residue analyses revealed a conglomerate of bitumen, vegetal fibers, and probable hairs adherent to the internal walls of the cavities. Discussion: The results are consistent with tool-assisted manipulation to remove necrotic or infected pulp in vivo and the subsequent use of a composite, organic filling. Fredian 5 confirms the practice of dentistry—specifically, a pathology-induced intervention—among Late Pleistocene hunter-gatherers. As such, it appears that fundamental perceptions of biomedical knowledge and practice were in place long before the socioeconomic changes associated with the transition to food production in the Neolithic.

Original languageEnglish
Pages (from-to)446-461
Number of pages16
JournalAmerican Journal of Physical Anthropology
Issue number3
StatePublished - Jul 2017
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017 Wiley Periodicals, Inc.


The authors dedicate this article to Mario Dini, a young researcher of the University of Pisa who died prematurely. Mario devoted most of his research to the study of the Paleolithic and Mesolithic sites in the Serchio river valley. He recovered the human remains from the deposits at Riparo Fredian and entrusted two of the authors (J. M.-C. and A. R.) to carry out a new and detailed study of them. AMS date was funded by the Exilarch's Foundation, the DANGOOR Research Accelerator Mass Spectrometry Laboratory (D-REAMS), and the Max Planck-Weizmann Center for Integrative Archaeology and Anthropology. JCW was funded by the Leakey Foundation. The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article. The datasets supporting this article have been uploaded as part of the Supporting Information.

FundersFunder number
DANGOOR Research Accelerator Mass Spectrometry Laboratory
Exilarch's Foundation
Max Planck-Weizmann Center
Leakey Foundation


    • Paleolithic
    • dental filling
    • dental treatment
    • late upper
    • oral hygiene
    • paleopathology


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