In the US, up to 15 percent of the population is afraid of the dentist. In the UK, it’s one in four. As phobias go, fear of the dentist is pretty universal. But these days there are drugs for the pain and counseling for the anxiety.

Now, imagine what going to the dentist would have been like in the Ice Age. Archaeologists in Italy have found the second-oldest evidence to date of dentistry, dating back 13,000 years, and the earliest known evidence of prehistoric fillings. Their study is published in the American Journal of Physical Anthropology.

The researchers found two incisors, which both come from the same person, in Riparo Fredian in Tuscany, northern Italy. Both teeth were found with holes drilled in them (from the surface right down into the pulp chamber) and filled with bitumen – a tar-like substance used to stick stone tools to handles – as well as plant fibers and hairs.

Because the “fillings” match when the holes were drilled, the researchers say this shows they were knowingly used as fillings and were not simply the remains of food. Though the use of the plant fibers and hair is unknown, study lead Stefano Benazzi of the University of Bologna told New Scientist the bitumen would have been used as an antiseptic and to reduce pain and keep food out of the cavity to avoid infection, similar to modern dentistry.

_{The presence of bitumen in the teeth indicates a medicinal reason for the filling, the earliest example of therapeutic dentistry ever discovered. Gregorio Oxilia}

The teeth also showed signs of someone having scoured and removed soft inner tissue. Using microscopic techniques to get a look inside the holes, they found scrape marks and flaking on the inner walls that suggest the cavities were most likely enlarged using tiny stone tools to remove diseased parts of the teeth. Benazzi suggested it would have been as painful as it sounds, according to Science News.

The most significant aspect of this find, the authors write in their paper, is the discovery that “pathology-induced therapeutic dental intervention” – meaning the study and diagnosis of disease and subsequent medical action – occurred in hunter-gatherers as early as the Late Pleistocene period, much earlier than had been thought and long before humans transitioned to food production in the Neolithic.

The introduction of cereals and honey would bring with them an increase in dental problems for humans, but the authors speculate that it could have been the cultural changes happening in Europe at the time, with people from the East bringing with them new foods, and so new diets, that could have led to the “dawn of dentistry”.