ENCINITAS -- "Looks like we have our work cut out for us here," Dr. Al Fallah said as he took his first look inside the mouth of Ramses Villa.

Ramses, a 16-year-old San Marcos resident, had come to Fallah's Encinitas dental office on Friday with his mother and twin sister, Stephanie. The twins were about to be examined for treatment of amelogenesis imperfecta, a genetic condition that impedes the development of enamel, the hard, protective layer that covers teeth.

Examining the brother and sister for the first time, Fallah anticipated helping the twins by installing crowns to cover their soft but jagged, yellow teeth. That work alone, he estimated, would cost about $10,000 for each patient.

But there are more problems. Stephanie, who otherwise has a beautiful smile, will require extensive orthodontia procedures to correct some teeth that are so misaligned they sometimes cause her breathing problems.

Ramses' problem is more severe. His upper and lower teeth only touch in the very back of his mouth, making biting food a challenge and chewing equally awkward. The condition will require surgery to correct, Fallah said.

The work will take months, and just how it will be funded remains uncertain, but the brother and sister are hopeful they one day will be able to smile without feeling self-conscious, thanks to Fallah and other volunteers with Fresh Start, the Carlsbad-based nonprofit that provides reconstructive surgery internationally.

Following the examination Friday, Fallah said he can do some orthodontia work on the two himself and improve Stephanie's teeth with bonding, but that they both need crowns to protect their teeth in the long term.

Registered nurse Candise Flippin of Fresh Start said the twin's condition will require crowns made by specialists, and that she anticipates the restoration cost will go beyond what usually is covered by the nonprofit's fundraising.

The Villa family is uninsured and had first sought treatment at the private, nonprofit Vista Community Clinic, which began cleaning and strengthening Ramses' and Stephanie's endangered teeth about two years ago.

Clinic nurse Jenny Jones suggested the family also seek treatment with Fresh Start, where she used to work, and the Villa now are the first Fresh Start patients from Vista Community Clinic.

Fallah, who volunteers one day a month with Fresh Start, said he has seen cases of severe amelogenesis imperfecta in textbooks, but that he had never personally seen cases as bad as the twins.

"I've seen this condition before, just not all in the same person," he said about the Ramses.

The twins have been bravely resilient to the sometimes callous comments other youths can taunt them with.

"There's some kids who tease you about it, but I just ignore them," Stephanie said. "And if they don't stop, I'll tell them something, and they'll stop. One time it really made me mad, and I told a guy off."

Ramses said he sometimes is bothered by other boys who try to give him a hard time, but he stands up for himself and doesn't let them get to him. He has more understanding for younger kids, who are just curious when they ask him about his teeth.

"Little kids say, 'Oh, what happened to youth teeth?' " he said. "I just tell them, 'You better not eat a lot of candy. This will happen to you.' "

Amelogenesis imperfecta does make teeth susceptible to decay, and Fallah said the twins probably would lose their teeth eventually if not protected by crowns.

The condition is heredity. Their mother, Marina Villa, has it to a less severe extent. Stephanie and Ramses are the second set of twins in the family, and their 22-year-old siblings also have the condition, although not as bad. Their maternal grandfather also had the condition.

"It's hard, but it's not going to hold me back from anything," Stephanie said about how she copes with the condition.

Upcoming Fresh Start fundraisers could help raise money for helping the twins. Those fundraisers include the "Wake Up Women's Empowerment Breakfast" on Oct. 10 at the Handlery Hotel and Resort in Mission Valley. Tickets cost $20. Fresh Start's annual gala, the Butterfly Ball, is scheduled for Nov. 22 at the Hotel Del Coronado. Tickets cost $275.

More information about the fundraisers and about other ways of contributing to the nonprofit are available by calling (760) 448-2025.

Contact staff writer Gary Warth at (760) 740-5410 or gwarth@nctimes.com.