I am in need of tooth implants due to a jaw alignment problem. I do not like the idea of putting metals directly into my jawbone. I have been told a bridge is out of the question, and my present denture refuses to stay in place. I have to clench my teeth to keep it in place, which puts further pressure on the jaw and is not helping its alignment. I had a cartilage removed from my jaw 30 years ago, and there's a "clicking" from both sides of the jaw. M M, Wirral........

The removal of the cartilage from your jaw was a rather brutal attempt to realign your jaw one rarely practised now. According to London dentist Robert Hempleman, there are a few things which you should try first before resorting to a metal implant. One alternative is to have another good denture made. Also consider the possibly of wearing a splint at night in order to balance the occlusion.

Once the occlusion has settled down, you may then be able to have corrective work done on your teeth in order to maintain their position. The British Society for Occlusal Studies (PO Box 1048, Rugeley, Staffs, WS15 4YE) can put you in touch with a practitioner who specialises in this condition.

You are right to be wary of metals in your mouth. WDDTY panellist Jack Levenson, when reflecting on your case, pointed to the work of the Bristol Wear Debris Analysis Team (J Bone and Joint Surg, 1994; 76B: 701-12), whose research suggested a link between metal debris and disease. They discovered that particles of metals like nickel, chrome, titanium and cobalt (in this case from joint replacements) had worked their way into the liver, spleen, lymph nodes and bone marrow.

If a metal implant is inevitable, Robert Hempleman strongly recommends that you have all other metals in your mouth (and elsewhere) removed first. A metal implant may interact with metal fillings in your mouth, creating electrical currents. These may increase the amount of mercury released from any existing fillings. These electrical currents may also interfere with brain wave patterns.

Jack Levenson recommends a titanium implant, as this causes fewer allergic reactions. He stresses, however, that some individuals are highly allergic to it. Levenson's practice produces an information leaflet on root canals, mercury and other dental problems. Send a large SAE with your request to: Brompton Dental and Health Clinic, 221 Old Brompton Road, London SW5 0EA.