"What’s dentistry like in Spain?" I ask family friend Cristina Botella, who grew up amid the orange groves of Valencia. I have a full agenda for the short time I’m in her home town—castles to explore, art galleries to inspect, and dental offices to discover. "I don't know," she says. "You’re my dentist. What do you want to eat?" Lunch always comes first.

I’ve become convinced that the best way to experience Spain is to taste it. On the Iberian peninsula eating is an art, a lifestyle consideration, taken—and undertaken—with utmost seriousness. Lunch, for instance, is rarely the drive-through burger or sandwich gobbled over a computer keyboard that Americans accept as normal. The meal at mediodia is nothing short of gastronomy. Businesses are shut tight and the shutters drawn before two, and the populace goes purposefully to table. At five, the hour that many Americans are winding down the day, Spaniards throw open the shutters and head back to work for another three hours.

I am scheduled to visit Dr. José Canut, an eminent Valencian orthodontist. But we have time. The midday ritual starts with drinks, then the hors d’oeuvres called tapas— "something to pick at," Cristina’s brother Manuel murmurs, while the meal is prepared. So the plates arrive, not one or two but a wave of a half-dozen or so swept in on the expert arm of a well-starched waiter. That’s waiter, not waitress, and certainly not waitperson; political correctness is not a Spanish concept, and serving food is generally considered man’s work. There’s not an enchilada for six thousand miles. Think France without the sauces. Wedges of Spanish potato omelet might start things off, and thin slices of prosciutto-like Serrano ham polka-dotted with several varieties of sliced sausage. Asparagus with mayonnaise may appear, along with fried squid, herring and anchovies, sautéed octopus, and grilled peppers. A plate of cheeses, some very pungent, is almost mandatory. How about some pickled eggplant? Pass the olives.

Manuel is certain that Spanish dentists also take this much time for lunch. (A brochure I will see later for a dental congress in Madrid bears him out. The day’s schedule calls for six one-hour lectures starting at ten-thirty A.M. and ending at eight-thirty P.M., three hours each of morning and afternoon continuing education sliced neatly in half by a whopping three-and-a-half hour meal slot.) Now for salad: expect boiled eggs in it and fresh tuna sprinkled on top. Next comes steak or lamb chops or pork loin, in big enough slabs to make you think you’ve gone to heaven on the Atkins diet, until you see the side of French fries. Dessert could be rice pudding or a robust, eggy flan. Finally there’s coffee, or a chamomile infusion—good for the digestion. Crusty bread is customary. Ask for butter and the waiter will faintly frown. But he will bring it shortly, professionally, on a porcelain plate, and he will charge you fifty cents a pat.

Dr. Canut has set aside a pat of precious lunch time to receive me. The office is thoroughly modern, and it’s spacious. A bank of dental chairs waits for the afternoon crowd, silent soldiers at attention. "I was surprised by how small many dental offices seem to be in the United States," says Dr. Canut’s son José, who is also a dentist. Yet for all its efficiency, a dental office in Spain is not a place of business, not a store where you just walk in. It’s a residence, like a home. You ring the doorbell and wait outside until a dental assistant answers the door and politely invites you in. Office hours are astonishingly genteel to an American, typically three to seven P.M., or five to eight. Only on Tuesdays do the Canuts have morning hours as well. "Afternoons are when the kids can come," shrugs the younger Jose. Schoolchildren work hard and often don't get home until five or six in the afternoon. Six is not evening in Spain.

Valencia is a golden city of sand-colored medieval stone, surrounded by orchards at the edge of the blue Mediterranean. Flower pots hanging on crusty wrought-iron windows bubble over with brightly blooming geraniums. High walls and crenellated towers guard the crumbling city gates, through which multiple lanes of impatient traffic now race. There’s an old saying, still invoked, about the walls. Someone who’s not paying attention is said to be "a la luna de Valencia," or under the Valencian moon. The phrase refers to unwary people caught outside the walls in the old times when the ancient gates clanged shut for the night.

Spanish dentistry is determined not to be caught under the Valencian moon. But it has had to sprint hard to get inside the gate. In this land of deeply ingrained traditions, change has become the new constant. The sounds of modern Spain are not guitars strumming by the fountains, but cement mixers, jackhammers and mobile phones. Like it or not, dentistry is undergoing a dramatic metamorphosis of its own. It is taking on a different philosophy of training, and with it a different identity. The whole profession is getting a new face. Make that faces. The emerging profile of Spanish dentistry is double-decked, its Janus-like constitution reflected in the official name of the Spanish dental association, General Counsel of Colleges of Odontologists and Stomatologists of Spain. Odontologists are non-physician dentists. Stomatologists are physicians specializing in dentistry. They can all have a go at your mouth.

Blame the confusion on unification. Until 1986 Spanish dentists were always physicians. Then a mandate of the European Union (formerly European Community) to streamline and homogenize its members began softening up old nationalistic systems. The Euro, for example, an auspicious new pan-European currency, is scheduled to replace the peseta, lira, French franc and deutschmark in 2002. The dental version of the Euro is to remint dentistry into a calling easily transported to and recognized by other EU countries. Dentists in Britain and Scandinavia are not physicians, so the EU chose a non-medical common denominator for its new odontologist. Eminent voices in the United States argue now and again for dentistry’s unification with medicine. "The degree of choice for dentists," a retired American dental school dean says, "is not the DDS or the DMD, but the MD." In Spain, dentistry has gone the other way.

In the last thirteen years dentists could train either as physicians who then took a residency in dentistry, or as non-physician dentists. But the medical schools will shortly phase out their dental programs. Medically-trained dentists, stomatologists who, when they sign their English-language letters and articles, add "MD, DDS" after their names, fear the new system represents a dumbing down of dentistry. But dental students, the new breed of odontologists, think it a practical, eminently sensible, thoroughly modern development.

This professional polemic is a bit like horchata. In the summer, horchata is Valencia’s late-afternoon refreshment of choice. Horchata is a sweet milky drink pressed from the chufa, a bean-sized tuber sometimes called earth almond in English. Everywhere else in the world, the grassy chufa plant, or yellow nutsedge, is regarded—by farmers and agricultural agents, at any rate—as a noxious weed. In Valencia, it’s a treasure. Spain is used to living by its own values, which is what makes redefining dentistry for a united Europe so complicated.

At stake is not just the interpretation of a degree change, but a definition of professional standards. For instance, an upstart dental franchise has opened in a storefront across the street from the Canuts, and Mercedes Canut, an orthodontist who works with her dad, worries about what it portends for Spanish dentistry. "The young dentists just rotate through," she explains. "They’re there one day, and the next, they’re gone. Places like that can offer only fragmented, piecemeal care." The situation rankles and offends her professional pride.

Pride rules in Spain. People follow football, our soccer, for example, with the fervor of religion. In Madrid’s Plaza Mayor, the vast Renaissance-era open square in the heart of the old town, hundreds of delirious fans are holding a pep rally to support the Royal Madrid team. Scores of policemen and several paddy wagons surround the rowdy throng. But Manuel’s girlfriend Rosario de Gregorio still nervously rolls down her socks, which bear the logo of the Valencia team, and heads to the opposite end of the square. "They’re crazy," she says. "Who knows what they might do?"

Local collection agencies know exactly what to do. They exploit the pride. In Valencia the bill collectors often dress in tuxedos, or in campy Zorro outfits with black flat-brimmed hat, mask, and cape. Bearing signs that say, "collector," or "hunter," they stalk delinquent debtors, following the miscreants to work, to their favorite restaurant or bar, to the bank, the bakery and the dry cleaners. Then they follow them home again. This is no small public embarrassment in a highly social society, and a pedestrian society at that, whose narrow, serpentine streets, choked with automobiles, encourage extensive walking and close encounters with inquisitive neighbors.

"A tooth is more precious than a diamond," Miguel de Cervantes's Don Quixote declared almost four hundred years ago, and many latter-day Spanish consumers are dentally aware enough to risk running up a bill. Some, like Rosario, have dental insurance. The health insurance company Rosario works for, Sanitas, issued her a plastic card that looks like a credit card. The receptionist at her dentist’s swipes the card through the terminal on her desk and sees in an instant what Rosario’s benefits are. "People are so lucky in America," Rosario says, without irony. "They get the option of having silver fillings. I only get white ones, and they keep breaking." Yet dentists complain that most patients are the just-get-me-out-of-pain type. In this country of thirty-nine million, there is now a dental practitioner for every 2600 or so people. Suddenly the country is awash in dentists who have to scramble to educate their public to the benefits of modern odontology.

At the epicenter of professional change are the schools. The Faculty of Odontology at the University of Valencia, completely separate from the medical school, was built in 1991. Students there say the new brand of dentistry is independent, like in America, but it seems more reminiscent of Britain. The License in Odontology, licenciatura de odontología, is not actually a doctoral degree. There are as yet no board examinations, neither state board equivalents required to practice nor specialty boards to document excellence. In Spain your degree is your license. But the school also offers two- or three-year masters degree programs in American-style specialties, including prosthodontics, periodontics, endodontics, pediatric dentistry, orthodontics and oral and maxillofacial surgery. Two graduate orthodontics residents, Drs. Mar Torrella and Isabel Gonzalez, show me around the school, which is sleek and streamlined, in an institutional way, although I notice that every unit has a porcelain cuspidor. Most dental students are women—forty-seven out of seventy, for instance, in Valencia’s class of 1998.

Mar’s father, oral and maxillofacial surgery professor Dr. Fernando Torrella, is writing a book on dentistry’s most famous woman, St. Apollonia. The senior Dr. Torrella and a colleague have traveled Europe to document paintings and shrines to the patron saint of dentistry. Apollonia was an early Christian martyr who the Romans tortured before torching by pulling out her teeth. The dentists of Valencia maintain a memorial to the saint in Valencia’s Church of the Good Shepherd, a striking statue of a young woman holding an oversized molar in long forceps. February 9th is Apollonia’s feast day. Students and faculty take the day off and head to a social club named, appropriately, after St. Apollonia, for soccer matches, socializing and sharing the convivial local rice casserole called paella.

The Canuts display a ceramic dental scene in their office. The earthenware dentist figurine in this busy diorama boasts an array of modern instruments and an autoclave at his elbow. But the stiff little kiln-fired professional is also surrounded by distinctly old-fashioned apothecary jars, and the entire piece is made in classic Spanish style, ornate and colorful. The pint-size scene could be a metaphor for Spain, and particularly Spanish dentistry—a remarkable juxtaposition of old and new, tradition and innovation. The old is respected, the new is embraced. Despite the difference in their dental degrees, as long as the stomatologists and the odontologists can sit down to a paella together, the system will work.

It’s late in the day, but the cafés are still serving churros, those long ropes of fried fritter, with chocolate. "Did you enjoy your dental visits?" Manuel asks. "Good. It’s time for dinner."

From Inscriptions, Journal of the Arizona Dental Association, 13(2):5, 23-24, August 1999.  Dr. Eric Curtis is author of Hand to Mouth: Essays on the Art of Dentistry, Quintessence, 2002.

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