title: Does oral infection cause cardiovascular disease? Oral and moral challenges.
abstract: OBJECTIVE
  To address three questions: (i) does oral infection cause cardiovascular disease (CVD)? (ii) what kind of uncertainty is there in the relationship between oral infection and CVD? and (iii) how do we handle this uncertainty in practice: what should we do?
  
  
  METHODS
  Conceptual analysis with basis in standard methods in philosophy of science and ethics. In particular, the study refers to theories of causality and uncertainty, as well as decision making theory.
  
  
  RESULTS
  Whether oral infections cause CVD deeply depends on what we mean by causality. An investigation of the most prominent conceptions of causality suggests that it is far from obvious that oral infection causes CVD. A further analysis reveals that uncertainty occurs as risk, specific uncertainty, ignorance, and indeterminacy, which has implications for how we should handle oral infections. One option is to apply the precautionary principle. Another option is to attribute a cause owing to the strong social commitment to prevent CVD.
  
  
  CONCLUSIONS
  A conceptual analysis shows that it is not obvious that oral infections cause CVD and that the question of causality does not only involve descriptive issues of science but also moral matters of society. Hence, whether oral infections cause CVD is an ethical and not only a scientific issue.
authors.affiliation: Center for Medical Ethics, University of Oslo, Oslo, Norway.
authors.forename: Bjørn M
authors.initials: BM
authors.lastname: Hofmann
mesh_terms: D001675:Bioethics; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015984:Causality; D002986:Clinical Trials as Topic; D003657:Decision Making; D004198:Disease Susceptibility; D006801:Humans; D009014:Morals; D010510:Periodontal Diseases / Q000453:epidemiology*; D035501:Uncertainty