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As well as causing B12 deficiency, an increase in methylmalonic acid occurs, which is thought to result in loss of myelin in the peripheral nerves and, consequently, neuropathy, which may be symptomatic as early as 2 years into metformin treatment

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Dentistry Journal: The Impact of Vitamin Deficiencies on Oral Manifestations in Children Cleveland Clinic: Dry Mouth (Xerostomia) Mayo Clinic: "Sjogren's Syndrome" Merck Manuals: Salivary Gland Disorders National Institute of Dental and Craniofacial Research: Dry Mouth National Health Service: "Dry Mouth" MD Anderson Cancer Center: What Does Oral Thrush Look Like? Nutrients: Protein Intake and Oral Health in Older AdultsA Narrative Review Mayo Clinic Health System: "Are You Getting Too Much Protein?" Johns Hopkins Medicine: Protein Content of Common Foods Mayo Clinic: Vitamin A (oral route) FDA: Vitamins Dentistry Journal: Iron Deficiency Anemia and Its Impact on Oral HealthA Literature Review Journal of Nutrition and Metabolism: Associations between Zinc Deficiency, Taste Changes, and Salivary Flow Rates following Gastric Bypass and Sleeve Gastrectomy Surgeries Nutrients: Zinc Adequacy Is Essential for the Maintenance of Optimal Oral Health Harvard Health Publishing: Zinc: What it does for the body, and the best food sources Cleveland Clinic: Vitamin Deficiency StatPearls: Glossitis Harvard Health Publishing: What color is your tongue