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	"INTERVENTION" can be defined as any attempt to intervene or interrupt the usual sequence in the development of disease in man.
	This may be by the provision of treatment education help or social support
	Five modes of intervention have been described which form a continuum corresponding to the natural history of any disease. Health promotion Specific protection Early diagnosis and treatment Disability limitation Rehabilitation
1. HEALTH PROMOTION
	Health promotion is " the process of enabling people to increase control over , and to improve health ".
	It is not directed against any particular disease, but is intended to strngthen the host through a variety of approaches ( interventions ) .
	The well known interventions in this area are health education environmental modifications nutritional interventions lifestyle and behaviuoural changes
a. Health Education
	This is one of the most cost effective interventions.
	A large number of diseases could be prevented with little or no medical intervention if people were adequately informed about them and if they were encouraged to take necessary precaustions in time.
	Recognizing this truth, the WHO's constitution states that " the extention to all people of the benefits of medical psychological and related knowledge is essential to the fullest attainment of health".
	The targets for educational efforts may include the general public patients priority groups health providers community leaders, and decision makers
b. Environmental Modifications
	A comprehensive approach to health promotion requires environmental modifications, such as provision of safe water installation of sanitary latrines control of insects and rodents improvement of housing
	The history of medicine have shown that many infectious diseaseshave been successfully controlled in western countries through environmental modifications, even prior to the development of specific vaccines or chemotherapeutic drugs.
	environmental interventions are non-clinical and do not involve the physcian.
c. Nutritional Interventions
	These comprise food distribution and nutrition improvement of vulnerable groups child feeding programmes food fortification nutrition education
d. Lifestyle And Behavioural Changes
	The conventional public health measures or interventions have not been successful in making inroads into lifestyle reforms.
	The action of prevention in this case, is one of individual and community responsibility for health, the physcian and infact each health worker acting as an educator than a therapist.
	Health education is a basic element of all health activity.
	It is of paramount importance in changing the views, behaviour and habits of people.
	Since health promotion comprises a broad spectrum of activities, a well conceived health promotion programme would first attempt to identify the "target groups" or at-risk individuals in a population and then direct more appropriate message to them.
	Goals must be defined.
	Means and alternative means of accomplishing them must be explored.
	It involves 'organizational, political, social and economic interventions designed to facilitate environmental and behavioural adaptations that will improve or protect health".
2. SPECIFIC PROTECTION
	To avoid disease altogether is the ideal but this is possible only in a limited number of cases.
	The following are some of the currently available interventions aimed at specific protection immunization use of specific nutrients chemoprophylaxis protection against occupational hazards protection against accidents protection from carcinogens avoidance of allergens the control of specific hazards in the general environment, e.g., air pollution noise control control of consumer product quality and safety of foods, drugs, cosmetics etc.
Health Protection
	The term "Health Protection" which is quite often used is not synonymous with specific protection.
	Health protection is defined as " The provision of conditions for normal mental and physical functioning of the human being individually and in the group. it includes the promotion of health the prevention of sickness and curative and restorative medicines in all its aspects"
	In fact, health protection is conceived as an integral part of an overall community development programme, associated with activities such as literacy compaigns education and food production
	Thus health protection covers a much wider field of health activities than specific protection.
3. EARLY DIAGNOSIS AND TREATMENT
	A WHO Expert Committee defined early detection of health impairment as " the detection of disturbances of homoeostatic and compensatory mechanism while
	Thus, in order to prevent overt disease or disablement, the criteria of diagnosis should, if possible, be based on early biochemical morphological and functional changes that precede the occurrence of manifest signs and symptoms
	This is of particular importance in chronic diseases.
	Early detection and treatment are the main interventions of disease control.
	The earlier a disease is diagnosed and treated the better it is from the point of view of prognosis and preventing the occurrence of further cases ( secondary cases ) or any long-term disability.
	It is like stamping out the "spark" rather than calling the fire brigade to put out the fire.
	Strictly speaking, early diagnosis and treatment cannot be called prevention because the disease has already commenced in the host.
	However, since early diagnosis and treatment intercepts the disease process, it has been included in the schema of prevention, in as much as the goal of prevention is "to oppose or intercept a cause to prevent or dissipate its effect"
	Early diagnosis and treatment though not as effective and economical as " primary prevention " may be critically important in reducing the high morbidity and mortality in certain diseases such as essential hypertension cancer cervix, and breast cancer
	For many others such as tuberculosis leprosy, and STD early diagnosis and treatment are the only effective mode of intervention.
	Early effective therapy has made it possible to shorten considerably the period of communicability and reduce the mortality from active communicable disease.
Mass treatment
	A mass treatment approach is used in the control of certain diseases, e.g., yaws pinta bejel trachoma, and malaria
	The rationale for mass treatment programme is the existence of at least 4-5 cases of latent infection for each clinical ( incubating ) infection may develop disease at any time.
	In such cases, mass treatment is a critical factor ijn the interrution of disease transmission.
	There are many variants of mass treatment total mass treatment juvenile mass treatment selective mass treatment depending upon the nature and prevalence of disease in the community.
4. DISABILITY LIMITATION
	When a patient reports late in the pathogenesis phase, the mode of intervention is disability limitation.
	The objective of this intervention is to prevent or halt the transition of the disease process from impairment to handicap.
Concept of disability : ---
	The sequence of events leading to disability and handicap have been stated as follows.
	The WHO has defined these terms as follows impairment disability handicap
IMPAIRMENT
	An impairment is defined as " any loss or abnormality of psychological, physiological or anatomical structure or function", e.g., loss of foot, defective vision or mental retardation, progressive or regressive.
	Further one impairment may lead to the development of "secondary" impairments as in the case of leprosy where damage to nerves ( primary impairment ) may lead to the planter ulcers ( secondary impairment ).
DISABILITY
	Because of an impairment, the affected person may be unable to carry out certain activities considered normal for his age sex etc.
	This inability to carry out certain activities is termed "disability".
	A disability has been defined as " any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being".
HANDICAP
	As a result of disability, the person experiences certain disadvantages in life and is not able to discharge the obligations required of him and play the role expected of him in society.
	This is termed "handicap", and is defined as "disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal ( depending on age, sex, and social and cultural factors ) for that individual".
	Taking accidents as an example the above terms can be explained further as follows.

Accident ........	Disease ( or disorder)
Loss of foot ....	Impairment (extrinsic or intrinsic)
Cannot walk .....	Disability (objectified)
Unemployed ......	Handicap (socialized)

	The intervention in disability will often be social or environmental as well as medical.
	While impairment which is the earliest stage has a large medical component, disability and handicap which are later stages have large social and environmental components in terms of dependence and social cost.
Disability prevention : ---
	Another concept is "Disability prevention".
	It relates to all the levels of prevention
a.	reducing the occurrence of impairment, e.g., immunization against polio ( primary prevention );
b.	disability limitation by appropriate treatment (secondary prevention); and,
c.	preventing the transition of disability into handicap ( tertiary prevention)
	The major causes of disability impairments in the developing countries are communicable diseases malnutrition low quality of pernatal care and accidents
	These are responsible for about 70% of cases of disability in developing countries.
	Primary prevention is the most effective way of dealing with the disability problem in developing countries.
5. REHABILITATION
	Rehabilitation has been defined as "the combined and coordinated use of medical, social, educational and vocational measures for training and retaining the individual to the highest possible level of functional ability".
	It includes all measures aimed at reducing the impact of disabling and handicapping conditions and at enabling the disabled and handicapped to achieve social integration.
	Social integration has been defined as the active participation of disabled and handicapped people in the mainstream of community life.
	Rehabilitation medicine has emerged in recent years as a medical speciality.
	It involves disciplines such as physical medicine or physiotherapy occupational therapy speech therapy audiology psychology education social work vocational guidance, and placement services
	The following areas of concern in rehabilitation have been identified
a.	Medical rehabilitation :-- restoration of function.
b.	Vocational rehabilitation :-- restoration of the capacity to earn a livlihood.
c.	Social rehabilitation :-- restoration of family and social relationships.
d.	Psychological rehabilitation :-- restoration of personal dignity and confidence.
	rehabilitation is no longer looked upon as an extracurricular activity of the physician.
	The current view is that the responsibility of the doctor does not end when the temperature touches normal and stiches are removed".
	The patient must be restored and retained "to live and work within the limits of his disability but to the hilt of his capacity".
	As such medical rehabilitation should as2t very early in the process of medical treatment.
	Examples of rehabilitation are
	estabilishing schools for the blind.
	provision of aids for the crippled
	reconstructive surgery in leprosy
	muscle re-education and graded excercises in neurological disorders like polio
	change of profession for a more suitable one and modification of life in general in the case of tuberculosis, cardiac patients and others.
	The purpose of rehabilitation is to make productive people out of non-productive people.
	Health for all by 2000 AD aimed at providing "rehabilitation for all".
	it is now recognized that rehabilitation is a difficult and demandind task that seldom gives totally satisfactory results; but needs enthsiastic cooperation from different segments of society as well as expertise, equipment and funds not readily available for this purpose even in affluent societies.
	It is further recognized that interventions at earlier stages are more feasible, will yield results and are less demanding of scarce resources.

APPLICATION OF PREVENTIVE MEASURES TO DENTAL HEALTH
PRIMARY PREVENTION		SECONDARY PREVENTION	TERTIARY PREVENTION
Health Promotion	Specific Protection	Early Diagnosis & Treatment	Disability Limitaion	Rehabilitation
Dental health education Education for periodic dental examination. Good stands of nutrition, adjusted to development phases of life. Attention to personality development Genetic cpunselling Provision of optimum living conditions	Attention to personal oral hygiene Use of environmental controls, such as water fluoridation topical application of fluorides; and other preventive measures Protection against occupational and recreational hazards, e.g. use of mouth gaurds. use of specific, essential nutrients ( of which fluorine is one ) Protection from carcinogens, e.g. anti-smoking measures.	case finding measures, such as radiographs screening surveys, such as oral cancer screening programmes dental recall systems treatment of decayed teeth professional cleaning of the teeth elimination of infections provision of orthodontic appliances and spaces	Treatment to control dental caries and periodontal disease and to prevent further complications and sequelae. Provision of appliances to restore function and appearance Treatment of other oral diseases and conditions.	Education of individuals for appropriate use of dentures Pre-surgery and post-surgery education for oral surgery patients.

PREVENTION OF PERIODONTAL DISEASES
LEVELS	PRIMARY PREVENTION		SECONDARY PREVENTION	TERTIARY PREVENTION
Preventive Services	Health Promotion	Specific Protection	Early Diagnosis & Treatment	Disability Limitaion	Rehabilitation
Services provided by the individual	Periodic dental visit Demand for preventive services	Oral hygiene practices	Self examination and referral Use of dental services	Use of dental services	Use of dental services
Services provided by the community	Dental health education programs Promotion of research efforts Provision of oral hygiene aids Lobby efforts	Supervised school brushing programs	Periodic screening and referral Provision of dental services	Provision of dental services	Provision of dental services
Services provided by the dental professional	Patient education Plaque control recall reinforcement	Correction of tooth malalignment prophylaxis	Complete examination Scaling and curettage Corrective restorative, and occlusal services	Deep curettage Root planing Splinting Periodontal surgery Selective extractions	Removable fixed prosthodontics minor tooth movement