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However, some Late Pleistocene hunter\u2010gatherers 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\u2010gatherer recovered from Riparo Fredian (Tuscany, Italy).<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>The Fredian 5 human consists of an associated maxillary anterior dentition with antemortem exposure of both upper first incisor (I<jats:sup>1<\/jats:sup>) pulp chambers. The pulp chambers present probable antemortem modifications that warrant in\u2010depth 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 I<jats:sup>1<\/jats:sup>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The results are consistent with tool\u2010assisted manipulation to remove necrotic or infected pulp <jats:italic>in vivo<\/jats:italic> and the subsequent use of a composite, organic filling. Fredian 5 confirms the practice of dentistry\u2014specifically, a pathology\u2010induced intervention\u2014among Late Pleistocene hunter\u2010gatherers. 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajpa.23216","type":"journal-article","created":{"date-parts":[[2017,3,27]],"date-time":"2017-03-27T12:42:20Z","timestamp":1490618540000},"page":"446-461","source":"Crossref","is-referenced-by-count":40,"title":["The dawn of dentistry in the late upper Paleolithic: An early case of pathological intervention at Riparo Fredian"],"prefix":"10.1002","volume":"163","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5412-0997","authenticated-orcid":false,"given":"Gregorio","family":"Oxilia","sequence":"first","affiliation":[{"name":"Department of Biology University of Florence Via del Proconsolo, 12 Firenze 50122 Italy"},{"name":"Department of Cultural Heritage Laboratory of Anthropology, University of Bologna Via degli Ariani 1 Ravenna 48121 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavia","family":"Fiorillo","sequence":"additional","affiliation":[{"name":"Department of Cultural Heritage Conservation Science Laboratory for Cultural Heritage, University of Bologna Via degli Ariani 1 Ravenna 48121 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Boschin","sequence":"additional","affiliation":[{"name":"Study Centre for the Quaternary Period (CeSQ) Via Nuova dell'Ammazzatoio 7 Sansepolcro Arezzo I\u201052037 Italy"},{"name":"Department of Physical Sciences Earth and Environment, University of Siena, Research Unit in Prehistory and Anthropology Via Laterina 8 Siena 53100 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Boaretto","sequence":"additional","affiliation":[{"name":"Max Planck\u2010Weizmann Center for Integrative Archaeology and Anthropology D\u2010REAMS Radiocarbon Laboratory, Weizmann Institute of Science Rehovot 7610001 Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore A.","family":"Apicella","sequence":"additional","affiliation":[{"name":"Department of Cultural Heritage Conservation Science Laboratory for Cultural Heritage, University of Bologna Via degli Ariani 1 Ravenna 48121 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Matteucci","sequence":"additional","affiliation":[{"name":"Department of Cultural Heritage Conservation Science Laboratory for Cultural Heritage, University of Bologna Via degli Ariani 1 Ravenna 48121 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Panetta","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, IFC\u2010CNR Via G. 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