Rebuilding Pascale's teeth after sustained epilepsy injuries

My sister needs to have her five front teeth replaced after years of falls caused by epileptic seizures. As other procedures have failed, her last option is costly dental prosthesis.

When my sister, Pascale, was 14 she was diagnosed with epilepsy. She began having regular tonic-clonic seizures. These were frightening to see, but no one could really understand how frightening it was to be happening in your own brain, except the youngest member of our family. Formerly known as grand mal seizures, tonic-clonic seizures are characterised by a complete loss of consciousness and violent convulsions. As such, people who experience these seizures are extremely vulnerable to injuries. At home, in shops, on the street, Pascale was prone to having seizures anywhere.

Some people with epilepsy have auras, which signal the beginning of a seizure. This happens before any loss of consciousness. It provides a warning and allows the person to get themselves to safety. Pascale’s seizures have never come with auras. Worse still, her condition was resistant to medication. Drug-resistant epilepsy accounts for about 20% of people with the disease. Throughout her adolescence, Pascale unsuccessfully tried many different types of medication. The seizures continued, occurring several times each month. In the first few years, Pascale would generally fall backwards, sometimes hitting her head. She had few injuries that required medical assistance. But as she got older, inexplicably, she increasingly fell forwards, directly onto her face.

I vividly recall getting a phone call: her name flashed up on my phone screen and I was excited to talk to her because I had been away for a while and hadn’t seen her yet. But instead of hearing her voice, it was her panicked friends trying to explain that she had faceplanted onto the asphalt of a basketball court where they were hanging out. Her front teeth were scattered across the ground. Her face was a bloody mess. I put them in touch with my parents, who told them to ring an ambulance. Mum and Dad drove up to the hospital, and told me that Pascale looked like she’d been in a car crash. Apparently, everyone at the hospital looked on in horror at her bloodstained face. This was the first time her teeth shattered out.

More falls came, always forwards, onto the face. Pascale became a regular at Exeter Hospital’s Max-Fax department. (Maxillofacial surgery is a specialist type of dentistry for reconstructing teeth, jaws, and mouth.) My sister has knocked her teeth out five times. At the basketball court, all five came out. After that, they came out in different numbers. She has had dozens of procedures to fix her mouth. The fillings, veneers, crowns and bonds have all failed.

Here's a brief summary of the work Pascale has had done and the state of the teeth.

• She was given crowns from the NHS. These were meant to last for 10 years, but they haven’t even lasted for two. The crowns have been vulnerable to regular infections.

• Apicectomies have been performed to remove infections.

• All five teeth have had root canal fillings, twice.

• Two of the teeth have resorption: a painful process where the structure of a tooth is broken down and absorbed by the body.

She is going to have her five front teeth replaced with three implants and two bridges. This is the only option. If her teeth are left as they are, they will continue to get infected, cause pain, develop abscesses and then fall out. Because of the cost, the NHS won’t fund this.

The procedures will take place over a period of roughly six months.

• First, the teeth will be extracted.

• A ten-week period of healing will follow the extractions. During this time, Pascale will wear a mouthguard with false teeth.

• The implants will be inserted once the gum has healed.

• A two-month period of healing will follow while the jawbone moulds round the titanium implants, a process known as osseointegration.

• A temporary bridge will be inserted into the mouth, to ascertain if the fit and shape is correct.

• The final part of the process will be the fitting of the crowns.

When Pascale told me she was going to use her own money to have this done, at the eyewatering cost of £15,000, I thought her money should instead be spent on the cost of her upcoming postgraduate course. Her diagnosis shook our family at the time, and its ongoing effects continue to impact all our lives. She has had epilepsy for nearly 15 years now, and I believe she deserves some ease as she pursues her goals in music. With a set of new front teeth that look like teeth, I trust she will be able to flourish freely and confidently in the next chapter of her life.

In September Pascale is going to do a masters in music. It is unclear how much the prosthetic work will impact her ability to sing. It’s a big step, and after all the challenges she’s met over the years, with tenacity and courage, I want to offer as much as support as I can with her ambitious undertaking. I hope you will consider helping me help my sister. This crowdfunder was solely my idea but Pascale was happy to give me the green light. I sat down with her and asked her to recount the story of her teeth. I hope this marks the end of the story.

Thank you,

Dom x

Postscript: a note on dental tourism

A number of people have suggested going abroad for these procedures. While it’s true that implants can be considerably cheaper, this isn’t a feasible option for Pascale, who requires at least seven appointments. With her condition, it’s unrealistic for her to travel back and forth on her own. There are also significant risks pertaining to any failure the implants might suffer, which would require complex treatment. I have looked into getting an implant abroad for myself and saw that the rising trend in dental tourism is far from straightforward. A key issue is litigation: dentists in the UK are required to have professional indemnity insurance, which covers their liability for any treatment they perform. However, this insurance generally does not cover work done by another dentist, especially if that work was performed abroad.