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3 In B12 deficiency, methylmalonic acid (MMA) can accumulate, and it is thought that elevated MMA, alongside elevated homocysteine, contributes to damage of the myelin sheath (which protects nerve cells and speeds up nerve transmission), which can cause irreversible neurological problems

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3.3.5 Clinical signs These may include restriction of mouth opening, changes in mucosal appearance (e.g., whitening, stiffness), and alterations in tissue pliability or flexibility, often assessed through clinical examination

332,333,334 A previous study also reported that patients who lack adequate social support are more likely to experience MDD