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[5] [6] However, it is important to emphasise that not all mouth ulcers are caused by B12 deficiency , and other factors such as immune dysfunction, genetic predisposition, and local trauma also play important roles

Mechanisms include reduction of excitotoxicity and oxidative stress, enhanced neurotrophic factor expression supporting neuronal survival, angiogenesis improving cerebral blood flow, and modulation of dopamine and serotonin systems

The federal government sets minimum coverage requirements, but states have significant flexibility in designing their benefit packages

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