Dental Health in Preschool and Schoolchildren in Relation to Dental Fear and Some Fear-Related Factors, and the Outcome of a Caries Prevention Program in Offspring of Fearful Mothers

Dental caries and dental fear and anxiety (DFA) are common interrelated problems but so far little is known about these problems in Estonia. The aim was to study dental health in relation to DFA, some fear-related factors, and to study the effect of a caries prevention program in children of fearful mothers. Dental health and DFA were assessed in two Estonian [2-4-year-olds (n=472) and 8-10-year-olds (n=344)], and the effect of some medical conditions on DFA in one Finnish child group [3-year-olds (n=148)]. 120 mother-child-pairs participated in the xylitol-based prevention program. Dental health was examined using the WHO or the ICDAS criteria and expressed as dmft/DMFT-indices. The modified children’s fear survey schedule dental subscale (MCFSS-DS) was used to assess DFA of schoolchildren, one single question to assess parental DFA, and the Corah’s dental anxiety scale (DAS) to assess DFA of mothers in the prevention study. Dentine caries was diagnosed in 42% of the 2-4-year-old and in 93% of the 8-10-year-old Estonian children. DFA of 8-10-year-olds (17%) was associated with experience of dental treatment, and maternal and paternal DFA. Dental apprehension at 9 years of age was associated with frequent exposure to invasive medical care. The xylitol-based prevention was successful irrespective of poor dental hygiene habits and maternal severe DFA. In conclusion, experience of operative dental treatment and DFA of Estonian children were closely associated. Invasive medical care and parental DFA were also linked to children’s DFA. Habitual use of xylitol by mothers was effective in preventing caries even in children of severely fearful mothers.

Additional revenue opportunities in pulp mills and their impacts on the kraft process

Although the concept of multi-products biorefinery provides an opportunity to meet the future demands for biofuels, biomaterials or chemicals, it is not assured that its implementation would improve the profitability of kraft pulp mills. The attractiveness will depend on several factors such as mill age and location, government incentives, economy of scale, end user requirements, and how much value can be added to the new products. In addition, the effective integration of alternative technologies is not straightforward and has to be carefully studied. In this work, detailed balances were performed to evaluate possible impacts that lignin removal, hemicelluloses recovery prior to pulping, torrefaction and pyrolysis of wood residues cause on the conventional mill operation. The development of mill balances was based on theoretical fundamentals, practical experience, literature review, personal communication with technology suppliers and analysis of mill process data. Hemicelluloses recovery through pre-hydrolysis of chips leads to impacts in several stages of the kraft process. Effects can be observed on the pulping process, wood consumption, black liquor properties and, inevitably, on the pulp quality. When lignin is removed from black liquor, it will affect mostly the chemical recovery operation and steam generation rate. Since mineral acid is used to precipitate the lignin, impacts on the mill chemical balance are also expected. A great advantage of processing the wood residues for additional income results from the fact that the pulping process, pulp quality and sales are not harmfully affected. For pulp mills interested in implementing the concept of multi-products biorefinery, this work has indicated possible impacts to be considered in a technical feasibility study.

The Effect of Plant Closures on Market Value: Empirical Evidence from Pulp and Paper Industry 2004-2012

The aim of this study was to research how plant closure announcements affect the market value of the largest pulp and paper industry companies in the world. Also the effect of announcements on competitors was researched and whether the location of plants, timing, reasons for the closures, and characteristics of the closing firms and competitors have an impact on the results. The overall sample included 57 events in the years 2004-2012 and event study was used as a research method. Main theories were signaling theory and spillover effect. According to empirical results, investors consider plant closure announcements as a positive signal for market value. The spillover effect on competitors was, on average, positive and characteristics of the firms and closures had an effect on the results. Furthermore, the market generally predicted the closures and overreacted to them on the announcement day and after it. It is possible for corporate management and investors to learn from the results and use them as support for their decision making.

Effects of the partial removal of wood hemicelluloses on the properties of kraft pulp

The objective of this work was to study the effects of partial removal of wood hemicelluloses on the properties of kraft pulp.The work was conducted by extracting hemicelluloses (1) by a softwood chip pretreatment process prior to kraft pulping, (2) by alkaline extraction from bleached birch kraft pulp, and (3) by enzymatic treatment, xylanase treatment in particular, of bleached birch kraft pulp. The qualitative and quantitative changes in fibers and paper properties were evaluated. In addition, the applicability of the extraction concepts and hemicellulose-extracted birch kraft pulp as a raw material in papermaking was evaluated in a pilot-scale papermaking environment. The results showed that each examined hemicellulose extraction method has its characteristic effects on fiber properties, seen as differences in both the physical and chemical nature of the fibers. A prehydrolysis process prior to the kraft pulping process offered reductions in cooking time, bleaching chemical consumption and produced fibers with low hemicellulose content that are more susceptible to mechanically induced damages and dislocations. Softwood chip pretreatment for hemicellulose recovery prior to cooking, whether acidic or alkaline, had an impact on the physical properties of the non-refined and refined pulp. In addition, all the pretreated pulps exhibited slower beating response than the unhydrolyzed reference pulp. Both alkaline extraction and enzymatic (xylanase) treatment of bleached birch kraft pulp fibers indicated very selective hemicellulose removal, particularly xylan removal. Furthermore, these two hemicellulose-extracted birch kraft pulps were utilized in a pilot-scale papermaking environment in order to evaluate the upscalability of the extraction concepts. Investigations made using pilot paper machine trials revealed that some amount of alkalineextracted birch kraft pulp, with a 24.9% reduction in the total amount of xylan, could be used in the papermaking stock as a mixture with non-extracted pulp when producing 75 g/m2 paper. For xylanase-treated fibers there were no reductions in the mechanical properties of the 180 g/m2 paper produced compared to paper made from the control pulp, although there was a 14.2% reduction in the total amount of xylan in the xylanase-treated pulp compared to the control birch kraft pulp. This work emphasized the importance of the hemicellulose extraction method in providing new solutions to create functional fibers and in providing a valuable hemicellulose co-product stream. The hemicellulose removal concept therefore plays an important role in the integrated forest biorefinery scenario, where the target is to the co-production of hemicellulose-extracted pulp and hemicellulose-based chemicals or fuels.

e-Business and collaboration: A case study of pulp supply chain

This thesis studies how the case company could digitalize its supply chain and what kind of advantages this would create in the light of supply chain efficiency. The case company manufactures several pulp products that are used for paper, fabrics and packaging products by customers worldwide. The paper and pulp industry has been paying more and more attention to increasing supply chain efficiency with new operating and service models made possible by today’s information technology. The main focus of this study is on the supply chain between the case company and its key customers and the goal is to find ways to make the operations between them as efficient as possible. The study relays heavily on collaboration techniques and digitalization technologies. In addition to a theoretical framework, the study includes several empirical studies that offer real-life examples of how these theories and technologies are applied in operating environments similar to the case company. A plan with strategic and operational levels is created according to the findings of the previous sections to support the case company’s future operations. The plan is based on an RFID-supported collaboration model that aims to advance information sharing between the supply chain partners. The time for an RFID-investment is sought to be very optimal and the benefits of such system to be noteworthy, but challenging to measure in monetary terms.

Production planning and optimization of a pulp mill: introduction of the optimisation based scheduling software for pulp industry

The objective of this project was to introduce a new software product to pulp industry, a new market for case company. An optimization based scheduling tool has been developed to allow pulp operations to better control their production processes and improve both production efficiency and stability. Both the work here and earlier research indicates that there is a potential for savings around 1-5%. All the supporting data is available today coming from distributed control systems, data historians and other existing sources. The pulp mill model together with the scheduler, allows what-if analyses of the impacts and timely feasibility of various external actions such as planned maintenance of any particular mill operation. The visibility gained from the model proves also to be a real benefit. The aim is to satisfy demand and gain extra profit, while achieving the required customer service level. Research effort has been put both in understanding the minimum features needed to satisfy the scheduling requirements in the industry and the overall existence of the market. A qualitative study was constructed to both identify competitive situation and the requirements vs. gaps on the market. It becomes clear that there is no such system on the marketplace today and also that there is room to improve target market overall process efficiency through such planning tool. This thesis also provides better overall understanding of the different processes in this particular industry for the case company.

Pressforming of a tray from a pulp sheet

The aim of this thesis work was to verify the possibility to produce tray packages directly from pulp sheets using press forming techniques. The different existing raw materials of pulp, various sources of molded pulp and different methods of production of molded pulp were studied. Nine different raw materials which were used for experimental work were provided by Stora Enso mills, and Stora Enso Research Centre, Imatra, Finland. The laboratory tests were carried out using LUT Adjustable packaging line at Lappeenranta University of Technology. The results prove that long virgin fibres of pine pulp seems to have better formability with high moisture content compared to others. No significant improvements were noticed with conditioned samples, never the less far studies has to be done to find optimal conditions for production. The results indicated the possibility for making pressformed tray from two different pulp qualities (Sunila pulp and Enopine). The method could prove to be beneficiary as the production line could be shortened and investment in board machines could be avoided if the trays were pressed directly from pulp sheets. Also the labour costs would be reduced. However, there is much work to be done before the quality of a tray produced out of a pulp sheet is comparable to a tray produced out of tray board.

Dental fear in adolescents' transition to early adulthood

The aims of the study were to assess the validity of a clinical dental fear question (Short Dental Fear Question, SDFQ) and an instrument measuring interaction between adolescents and dental staff (Patient Dental Staff Interaction Questionnaire, PDSIQ). Also, adolescents’ subjective perception of interaction with dental staff, the association with adolescents’ dental fear and sense of coherence as well as a multi-professional small-group intervention model for decreasing high dental fear were assessed. The study sample comprised Finnish adolescents in transition to early adulthood, aged 18–26 years (n = 777, n = 773, n = 5), except for a sample of 15-year-old adolescents (n = 27). Dental fear, sense of coherence (SOC) and the adolescents’ perceived interaction with dental staff were assessed with questionnaires. The principles of fear treatment such as gradual exposure, relaxation, encouragement and cornerstones of the reteaming method based on a solution-focused framework to maintain motivation and peer support were used to decrease fear in the intervention study. The SDFQ was found to be a valid dental fear instrument and the PDSIQ a valid interaction instrument with five factors of interaction retrieved: ‘kind atmosphere and mutual communication’, ‘roughness’, ‘insecurity’, ‘trust and safety’, and ‘shame and guilt’. Highly fearful young adults more often perceived their interaction with dental staff as negative, more often felt insecure and had a weaker sense of coherence compared to their peers with no to moderate dental fear. The results of the intervention study showed that young adults’ high dental fear decreased and their commitment to dental treatment increased. The SDFQ is clinically feasible and informative instrument in measuring dental fear. Knowledge of the level of fear enables dental staff to better consider an adolescent’s fear. Dental staff should be aware that a supportive interaction style, creating trust and safety, is especially beneficial for highly dentally fearful young adults. A weak SOC may affect young adults’ high dental fear in that they would not have enough tools to manage their fear. A multi-professional small therapeutic group seems to increase fearful young adults’ resources for confronting dental treatment.

Explaining the Shifts of International Trade in Pulp and Paper Industry

The pulp and paper industry is currently facing broad structural changes due to global shifts in demand and supply. These changes have significant impacts on national economies worldwide. In this paper, we describe the recent trends in the pulp and recovered paper (RP) production, and estimate augmented gravity models of bilateral trade for chemical pulp and RP exports with panel data. According to our results, there is some variation in the effects of the traditional gravity-model variables between pulp grades and RP. The results imply also that, in comparison to export supply, import demand plays a larger role in determining the volume of exports. Finally, it is evident that Asia, particularly China, is the most important driver of chemical pulp and RP trade: China is hungry for fiber, and must import to satisfy its growing needs. Moreover, the speed of China’s growth in chemical pulp and RP imports has been driving the increased significance of planted forests in the exports of hardwood pulp (BHKP) as well.

Structural dynamics in the global pulp and paper industry

The pulp and paper industry is currently facing broad structural changes due to global shifts in demand and supply. These changes have significant impacts on national economies worldwide. Planted forests (especially eucalyptus) and recovered paper have quickly increased their importance as raw material for paper and paperboard production. Although advances in information and communication technologies could reduce the demand for communication papers, and the growth of paper consumption has indeed flattened in developed economies, particularly in North America and Western Europe, the consumption is increasing on a global scale. Moreover, the focal point of production and consumption is moving from the Western world to the rapidly growing markets of Southeast Asia. This study analyzes how the so-called megatrends (globalization, technological development, and increasing environmental awareness) affect the pulp and paper industry’s external environment, and seeks reliable ways to incorporate the impact of the megatrends on the models concerning the demand, trade, and use of paper and pulp. The study expands current research in several directions and points of view, for example, by applying and incorporating several quantitative methods and different models. As a result, the thesis makes a significant contribution to better understand and measure the impacts of structural changes on the pulp and paper industry. It also provides some managerial and policy implications.

Evaluation of novel programs in health counseling – their effectiveness in the oral health of young children, and their acceptance by parents and professionals in public dental service.

Aim and design: To evaluate family-based health counseling for young children, and to study the significance of adding parental self-care or the training of professionals to the programs. The effectiveness and acceptability of the programs were evaluated by comparing two new programs with an earlier one. Subjects and methods: The study was carried out in Vantaa, which was divided into three study areas. The subjects consisted of children born in 2008, particularly fi rstborn children, while children born in 2006 formed the historical control. The fi rst of the new programs emphasized oral hygiene and use of fl uoride, and the second program focused on proper diet and use of xylitol. The main outcome measure was mutansstreptococci (MS) in the dental biofi lm of two-year-olds, and the opinions of parents and dental professionals were evaluated using questionnaires. Results: The programs found wide acceptance among dental professionals. There were no group-related differences found in the MS scores of the two-year-olds. However, all groups combined, father’s advanced level of education and child’s proper use of xylitol were associated with negative MS scores. In the opinion of parents, the oral healthcare guidance at least somewhat met their expectations. Conclusions: The present fi ndings suggest that providing training and support for professionals in health education is important. The addition of parental self-care to supplement programs aimed at young children does not improve the program, although it may improve parental readiness to change their own health habits. Counseling for families might be best carried out through a routine patient-centered program.

Fiber-reinforced composite fixed dental prostheses: Studies of the materials used as pontics

Fiber-reinforced composite fixed dental prostheses – Studies of the materials used as pontics University of Turku, Faculty of Medicine, Institute of Dentistry, Department of Biomaterials Science, Finnish Doctoral Program in Oral Sciences – FINDOS, Annales Universitatis Turkuensis, Turku, Finland 2015 Fiber-reinforced composites (FRC), a non-metallic biomaterial, represent a suitable alternative in prosthetic dentistry when used as a component of fixed dental prostheses (FDPs). Some drawbacks have been identified in the clinical performance of FRC restorations, such as delamination of the veneering material and fracture of the pontic. Therefore, the current series of studies were performed to investigate the possibilities of enhancing the mechanical and physical properties of FRC FDPs by improving the materials used as pontics, to then heighten their longevity. Four experiments showed the importance of the pontic design and surface treatment in the performance of FRC FDPs. In the first, the load-bearing capacities of inlay-retained FRC FDPs with pontics of various materials and thicknesses were evaluated. Three different pontic materials were assessed with different FRC framework vertical positioning. Thicker pontics showed increased load-bearing capacities, especially ceramic pontics. A second study was completed investigating the influence of the chemical conditioning of the ridge-lap surface of acrylic resin denture teeth on their bonding to a composite resin. Increased shear bond strength demonstrated the positive influence of the pretreatment of the acrylic surfaces, indicating dissolution of the denture surfaces, and suggesting potential penetration of the monomer systems into the surface of denture teeth. A third study analyzed the penetration depth of different monomer systems on the acrylic resin denture teeth surfaces. The possibility of establishing a durable bond between acrylic pontics and FRC frameworks was demonstrated by the ability of monomers to penetrate the surface of acrylic resin denture teeth, measured by a confocal scanning type microscope. A fourth study was designed to evaluate the load-bearing capacities of FRC FDPs using the findings of the previous three studies. In this case, the performance of pre-shaped acrylic resin denture teeth used as pontics with different composite resins as filling materials was evaluated. The filling material influenced the load-bearing capacities, providing more durable FRC FDPs. It can be concluded that the mechanical and physical properties of FRC FDPs can be improved as has been shown in the development of this thesis. The improvements reported then might provide long lasting prosthetic solutions of this kind, positioning them as potentially permanent rehabilitation treatments. Key words: fiber-reinforced composite, fixed dental prostheses, inlay-retained bridges, adhesion, acrylic resin denture teeth, dental material.

Separation of lignin in Pulp Mill process and its effect on sodium sulphur balance

The aim of this thesis is to define effects of lignin separation process on Pulp mill chemical balance especially on sodium/sulphur-balance. The objective is to develop a simulation model with WinGEMS Process Simulator and use that model to simulate the chemical balances and process changes. The literature part explains what lignin is and how kraft pulp is produced. It also introduces to the methods that can be used to extract lignin from black liquor stream and how those methods affect the pulping process. In experimental part seven different cases are simulated with the created simulation model. The simulations are based on selected reference mill that produces 500 000 tons of bleached air-dried (90 %) pulp per year. The simulations include the chemical balance calculation and the estimated production increase. Based on the simulations the heat load of the recovery boiler can be reduced and the pulp production increased when lignin is extracted. The simulations showed that decreasing the waste acid stream intake from the chlorine dioxide plant is an effective method to control the sulphidity level when about 10 % of lignin is extracted. With higher lignin removal rates the in-mill sulphuric acid production has been discovered to be a better alternative to the sulphidity control.