title: The dawn of dentistry in the late upper Paleolithic: An early case of pathological intervention at Riparo Fredian.
abstract: 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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Biology, University of Florence, Via del Proconsolo, 12, Firenze, 50122, Italy.|Department of Cultural Heritage, Laboratory of Anthropology, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.
authors.forename: Gregorio
authors.identifier: 0000-0001-5412-0997
authors.initials: G
authors.lastname: Oxilia
authors.affiliation: Department of Cultural Heritage, Conservation Science Laboratory for Cultural Heritage, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Fiorillo
authors.affiliation: Study Centre for the Quaternary Period (CeSQ), Via Nuova dell'Ammazzatoio 7, Sansepolcro, Arezzo, I-52037, Italy.|Department of Physical Sciences, Earth and Environment, University of Siena, Research Unit in Prehistory and Anthropology, Via Laterina 8, Siena, 53100, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Boschin
authors.affiliation: Max Planck-Weizmann Center for Integrative Archaeology and Anthropology, D-REAMS Radiocarbon Laboratory, Weizmann Institute of Science, Rehovot, 7610001, Israel.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Boaretto
authors.affiliation: Department of Cultural Heritage, Conservation Science Laboratory for Cultural Heritage, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.
authors.forename: Salvatore A
authors.initials: SA
authors.lastname: Apicella
authors.affiliation: Department of Cultural Heritage, Conservation Science Laboratory for Cultural Heritage, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Matteucci
authors.affiliation: Institute of Clinical Physiology, IFC-CNR, Via G. Moruzzi 1, Pisa, 56124, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Panetta
authors.affiliation: Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Sant'Alberto 163, Ravenna, 48123, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Pistocchi
authors.affiliation: Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Sant'Alberto 163, Ravenna, 48123, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Guerrini
authors.affiliation: Department of Cultural Heritage, Laboratory of Anthropology, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Margherita
authors.affiliation: School of Science, University of Bologna, Via dell'Agricoltura 5, Ravenna, 48123, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Andretta
authors.affiliation: Department of Cultural Heritage, Laboratory of Anthropology, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.|Department of Biological, Geological and Environmental Sciences - BiGeA University of Bologna, Via Selmi 3, Bologna, 40126, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Sorrentino
authors.affiliation: Department of Biology, University of Pisa, via Derna 1, Pisa, 56125, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Boschian
authors.affiliation: Study Centre for the Quaternary Period (CeSQ), Via Nuova dell'Ammazzatoio 7, Sansepolcro, Arezzo, I-52037, Italy.|Department of Physical Sciences, Earth and Environment, University of Siena, Research Unit in Prehistory and Anthropology, Via Laterina 8, Siena, 53100, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Arrighi
authors.affiliation: Department of Biology, University of Florence, Via del Proconsolo, 12, Firenze, 50122, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Dori
authors.affiliation: Department of Cultural Heritage, Laboratory of Anthropology, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancuso
authors.affiliation: Study Centre for the Quaternary Period (CeSQ), Via Nuova dell'Ammazzatoio 7, Sansepolcro, Arezzo, I-52037, Italy.|Department of Physical Sciences, Earth and Environment, University of Siena, Research Unit in Prehistory and Anthropology, Via Laterina 8, Siena, 53100, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Crezzini
authors.affiliation: Department of Biology, University of Florence, Via del Proconsolo, 12, Firenze, 50122, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Riga
authors.affiliation: Department of Cultural Heritage, Laboratory of Anthropology, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Serrangeli
authors.affiliation: Department of Cultural Heritage, Laboratory of Anthropology, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Vazzana
authors.affiliation: Institute of Clinical Physiology, IFC-CNR, Via G. Moruzzi 1, Pisa, 56124, Italy.
authors.forename: Piero A
authors.initials: PA
authors.lastname: Salvadori
authors.affiliation: Department of Cultural Heritage, Conservation Science Laboratory for Cultural Heritage, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Vandini
authors.affiliation: Department of Civilisations and Forms of Knowledge, University of Pisa, Via Pasquale Paoli, 15, Pisa, 56126, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tozzi
authors.affiliation: Study Centre for the Quaternary Period (CeSQ), Via Nuova dell'Ammazzatoio 7, Sansepolcro, Arezzo, I-52037, Italy.|Department of Physical Sciences, Earth and Environment, University of Siena, Research Unit in Prehistory and Anthropology, Via Laterina 8, Siena, 53100, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Moroni
authors.affiliation: UCD School of Medicine, Health Science Centre, University College Dublin, Belfield, Dublin 4, Ireland.
authors.forename: Robin N M
authors.initials: RNM
authors.lastname: Feeney
authors.affiliation: Department of Anthropology, Campus Box 1114, Washington University, Saint Louis, Missouri, 63130.
authors.forename: John C
authors.initials: JC
authors.lastname: Willman
authors.affiliation: Department of Biology, University of Florence, Via del Proconsolo, 12, Firenze, 50122, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Moggi-Cecchi
authors.affiliation: Department of Cultural Heritage, Laboratory of Anthropology, University of Bologna, Via degli Ariani 1, Ravenna, 48121, Italy.|Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, Leipzig, 04103, Germany.
authors.forename: Stefano
authors.initials: S
authors.lastname: Benazzi
mesh_terms: D003731:Dental Caries / Q000266:history / Q000473:pathology / Q000628:therapy*; D003793:Dental Restoration, Permanent / Q000266:history*; D006665:History of Dentistry; D049690:History, Ancient; D006801:Humans; D007180:Incisor / Q000473:pathology; D007558:Italy; D010164:Paleopathology
keywords: Paleolithic; dental filling; dental treatment; late upper; oral hygiene; paleopathology