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Berberine is an unlicensed supplement with limited long-term evidence, whilst metformin is the NICE-recommended first-line treatment with proven safety and efficacy

Common complaints include: Increased tooth decay or cavities Some individuals notice new dental caries or worsening of existing decay, particularly along the gum line or between teeth Gum problems Gingivitis (gum inflammation), bleeding gums, receding gums, or periodontal disease may develop or worsen Tooth sensitivity Heightened sensitivity to hot, cold, or sweet foods and beverages Dry mouth (xerostomia) A persistent feeling of oral dryness, which can compromise the mouth's natural protective mechanisms Bad breath (halitosis) Persistent unpleasant breath odour that does not improve with routine oral hygiene Tooth discolouration or erosion Changes in tooth appearance, including yellowing, thinning of enamel, or visible wear patterns These symptoms may be indirectly related to the medication's mechanism of action and common adverse effects

But most patients experience an energizing sense of wellbeing soon after starting treatment