第六章 結論與建議
第三節 研究限制及未來研究之建議
一、本研究為立意取樣，僅以台北市某一醫學中心神經內科、神經外科、家醫科、
整合醫療、及老人醫學科病房為收案地點，因此研究結果無法推論至其他病 房、神經內外科加護病房或急診的急性中風病人。
二、本研究之問卷及口腔護理執行狀況量表為初次使用，未來仍需相關研究再測 試，以建立研究工具之信效度。
三、由於國內口腔衛生相關研究所使用的口腔照護知識及態度問卷多為研究者自 擬而成，問卷的題目深淺不一，所含納的相關概念亦不盡相同，故各個研究 結果所代表的知識及態度程度不完全相當，結果較難對照比較。
四、本研究以 3 題視覺類比量表題目評估病人對口腔健康的主觀感受，發現病人 對住院期間的口腔衛生狀況大致滿意，但得分範圍相差甚多，題目設計可能 未能反映出病人的真實感受，建議未來研究可加強問卷內容設計或運用質性 研究之訪談法，深入了解住院病人對口腔健康維護之看法。
五、本研究結果發現，口腔衛生知識、態度、及執行狀況總分皆較佳的病患服務 員，其所照顧個案的口腔衛生狀況反不如外籍看護的個案，其相關影響因素 在日後研究中可再予確認。
六、在探討口腔護理執行狀況方面，建議未來的研究採用臨床實際觀察方法來收 集資料，俾能了解其全貌及優劣之處。
70
參考文獻 中文參考文獻
王妙引(2013)‧長期照護機構照顧服務員協助老年住民口腔衛生照護行為之探討 (碩士論文)‧取自 http://140.131.94.7/handle/987654321/662
吳妮蓉、黃純德、鄭雅愛、謝尚廷、蕭思郁、紀乃智、劉旻育(2007)‧口腔衛生教 育介入對機構保育員的口腔保健認知態度及行為之影響‧中華牙醫學雜誌，
26(2)，226-233。
吳樺姍(2002)‧口腔黏膜改變患者之照護‧長庚護理，13(3)，251-257。
吳慧絹(2011)‧影響機構照顧服務員提供失智住民口腔衛生照護行為之探討(碩士 論文)‧取自 http://140.131.94.7/handle/987654321/969
宋博達(2011，9 月 7 日)‧假牙清潔知多少‧2013 年 10 月 13 日取自
http://www.vghtc.gov.tw/GipOpenWeb/wSite/ct?xItem=35373&ctNode=31473&
mp=55000
邱弘毅(2008)‧腦中風之現況與流行病學特徵‧腦中風會訊，15(3)，2-4。
許紘耀、黃國光、沈一慶(2005)‧口臭‧中華民國牙周病醫學會雜誌，10(2)，127-134。
莊靜如(2002)‧口腔衛生之道──潔牙工具知多少‧健康世界，200，80-86。
張博文(2010)‧機構內失智症照護經驗照護者的口腔衛生知識、態度、行為與口腔 照護經驗之關係：台灣中部地區之研究(碩士論文)‧取自
http://www.airitilibrary.com/Publication/alDetailedMesh1?DocID=U0011-270720 1014441200
張進順(2013)‧邁入高齡化的台灣社會-老人口腔照顧的新趨勢‧中華牙醫學會訊，
230，38-44。
黃琦婷(2009)‧台灣地區主要中風類型疾病率與醫療利用分析‧慈濟大學公共衛生 研究所碩士學位論文。
廖家祥、徐令儀、李柏堅(2009)‧蘆薈修護保濕凝膠製備與使用經驗分析‧中華技 術學院學報，(40)，441-454。
71
蔡恒惠(2012)‧高齡者與住院病患的口腔照護‧新臺北護理期刊，14(1)，1-5。
蔡麗紅(編著) (2010)‧舒適的需要：身體部位清潔的護理方法‧載於曹麗英等編著，
新編基本護理學(259-267 頁)‧臺北縣：新文京開發。
衛生福利部(2013，6 月 4 日)‧民國 101 年主要死因分析‧2013 年 8 月 17 日取自 http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no
=2747
衛生福利部(2012，12 月 28 日)‧二十大死因第三位腦血管疾病--按戶籍縣市鄉鎮 別統計 100‧2013 年 11 月 10 日取自 http://www.nhi.gov.tw/webdata/webdata.
aspx?menu=17&menu_id=1023&WD_ID=1043&webdata_id=4289 衛生福利部(2005，4 月 4 日)‧腦中風防禦守則‧2013 年 8 月 17 日取自
http://health99.hpa.gov.tw/educZone/edu_detail.aspx?CatId=20058&KeyWord=%
e4%b8%ad%e9%a2%a8&terms=0,0,0, ,1988/1/1,2013/12/31&kind=Search 賴志毅(譯) (2011)‧牙周疾病預防醫學(原作者：鴨井久一、花田信弘、佐藤勉、野
村義明)‧臺北市：合記。
蘇怡娟(2007)‧南區機構內老年失智症照護者口腔衛生知識、態度、行為調查(碩 士論文)‧取自
http://www.airitilibrary.com/Publication/alDetailedMesh1?DocID=U0011-130120 0821145200
72
英文參考文獻
Adachi, M., Ishihara, K., Abe, S., Okuda, K., & Ishikawa, T. (2002). Effect of
professional oral health care on the elderly living in nursing homes. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 94(2), 191-195.
Alberta Provincial Stroke Strategy(APSS) (2009, November). Inpatient care for acute stroke admissions. Retrieved August 24, 2013, from http://www.strokestrategy.ab.
ca/IP%20Novl909%20Final.pdf
American Stroke Association (2012, May 1). Impact of Stroke (Stroke statistics).
Retrieved August 17, 2013, from http://www.strokeassociation.org/STROKEO RG/AboutStroke/Impact-of-Stroke-Stroke-statistics_UCM_310728_Article.jsp Andersson, P., Hallberg, I. R., & Renvert, S. (2002). Inter-rater reliability of an oral
assessment guide for elderly patients residing in a rehabilitation ward. Special Care in Dentistry, 22(5), 181-186.
Andersson, P., Hallberg, I. R., Lorefält, B., Unosson, M., & Renvert, S. (2004). Oral health problems in elderly rehabilitation patients. International journal of dental hygiene, 2(2), 70-77.
Avcu, N., Ozbek, M., Kurtoglu, D., Kurtoglu, E., Kansu, O., & Kansu, H. (2005). Oral findings and health status among hospitalized patients with physical disabilities, aged 60 or above. Archives of gerontology and geriatrics, 41(1), 69-79.
Azarpazhooh, A., & Leake, J. L. (2006). Systematic review of the association between respiratory diseases and oral health. Journal of periodontology, 77(9), 1465-1482.
Berchier, C. E., Slot, D. E., Haps, S., & Van der Weijden, G. A. (2008). The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. International journal of dental hygiene, 6(4), 265-279.
73
Binkley, C., Furr, L. A., Carrico, R., & McCurren, C. (2004). Survey of oral care practices in US intensive care units. American journal of infection control, 32(3), 161-169.
Bissett, S., & Preshaw, P. (2011). Guide to providing mouth care for older people.
Nursing Older People, 23(10), 14-21.
Brady, M. C., Furlanetto, D. L., Hunter, R. V., Lewis, S. C., & Milne, V. (2007).
Improving oral hygiene in patients after stroke. Stroke, 38(3), 1115-1116.
Brady, M. C., Furlanetto, D. L., Hunter, R. V., Lewis, S. C., & Milne, V. (2008). Staff training improved oral hygiene in patients following stroke. Evidence-Based Dentistry, 9(3), 73-73.
Brady, M. C., Furlanetto, D. L., Hunter, R. V., Lewis, S. C., & Milne, V. (2011). Oral Health Care for Patients After Stroke. Stroke, 42(12), e636-e637.
Brady, M. C., Stott, D. J., Norrie, J., Chalmers, C., George, B., Sweeney, P. M., &
Langhorne, P. (2011). Developing and evaluating the implementation of a
complex intervention: using mixed methods to inform the design of a randomised controlled trial of an oral healthcare intervention after stroke. Trials, 12(1), 168.
British Society of Gerodontology (2010, June). Guidelines for the Oral Healthcare of Stroke Survivors. Retrieved August 28, 2013, from http://www.gerodontology.
com/forms/stroke_guidelines.pdf
Chalmers, J. M., & Pearson, A. (2005). A systematic review of oral health assessment by nurses and carers for residents with dementia in residential care facilities.
Special Care in Dentistry, 25(5), 227-233.
Choo, A., Delac, D. M., & Messer, L. B. (2001). Oral hygiene measures and promotion:
review and considerations. Australian Dental Journal, 46(3), 166-173.
Clayton, B. (2012). Stroke, Dysphagia and Oral Care: What is best practice? Alberta RN, 68(1), 26-27.
74
Cohen, J. (1992). A power primer. Psychological bulletin, 112(1), 155-159.
Coleman, P. (2002). Improving oral health care for the frail elderly: a review of widespread problems and best practices. Geriatric Nursing, 23(4), 189-199.
Costello, T., & Coyne, I. (2008). Nurses’ knowledge of mouth care practices. British Journal of Nursing, 17(4), 264-268.
Deacon, S. A., Glenny, A. M., Deery, C., Robinson, P. G., Heanue, M., Walmsley, A.
D., & Shaw, W. C. (2010). Different powered toothbrushes for plaque control and gingival health. The Cochrane Library. Retrieved May 19, 2015, from
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004971.pub2/abstract De Marchi, R. J., Hugo, F. N., Hilgert, J. B., & Padilha, D. M. (2008). Association
between oral health status and nutritional status in south Brazilian independent-living older people. Nutrition, 24(6), 546-553.
De Oliveira, C., Watt, R., & Hamer, M. (2010). Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. British Medical Journal, 340, c2451.
De Visschere, L. M., Grooten, L., Theuniers, G., & Vanobbergen, J. N. (2006). Oral hygiene of elderly people in long-term care institutions – a cross-sectional study.
Gerodontology, 23(4), 195-204.
Dharamsi, S., Jivani, K., Dean, C., & Wyatt, C. (2009). Oral care for frail elders:
knowledge, attitudes, and practices of long-term care staff. Journal of dental education, 73(5), 581-588.
Dickinson, H. (2012). Maintaining oral health after stroke. Nursing standard, 26(49), 35-39.
Dickinson, H., Watkins, C., & Leathley, M. (2001). The development of the THROAT:
The holistic and reliable oral assessment tool. Clinical Effectiveness in Nursing, 5(3), 104-110.
75
Dörfer, C. E., Becher, H., Ziegler, C. M., Kaiser, C., Lutz, R., Jörß, D., …Grau, A. J.
(2004). The association of gingivitis and periodontitis with ischemic stroke.
Journal of Clinical Periodontology, 31(5), 396-401.
Eilers, J., Berger, A. M., & Petersen, M. (1988). Development, testing, and application of the oral assessment guide. Oncology nursing forum, 15(3), 325-330.
Frenkel, H., Harvey, I., & Newcombe, R. G. (2001). Improving oral health in
institutionalised elderly people by educating caregivers: a randomised controlled trial. Community dentistry and oral epidemiology, 29(4), 289-297.
Frenkel, H., Harvey, I., & Needs, K. (2002). Oral health care education and its effect on caregivers' knowledge and attitudes: a randomised controlled trial. Community dentistry and oral epidemiology, 30(2), 91-100.
Gil-Montoya, J. A., de Mello, A. L. F., Cardenas, C. B., & Lopez, I. G. (2006). Oral health protocol for the dependent institutionalized elderly. Geriatric Nursing, 27(2), 95-101.
Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Borden, W.
B., …Turner, M. B. (2013). Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation, 127(1), e6-e245.
Gopal, A. (2008). Stroke and oral health. Vital, 5(3), 40-42.
Gosney, M., Martin, M. V., & Wright, A. E. (2006). The role of selective
decontamination of the digestive tract in acute stroke. Age and ageing, 35(1), 42-47.
Gotfredsen, K., & Walls, A. W. (2007). What dentition assures oral function? Clinical Oral Implants Research, 18(s3), 34-45.
Grap, M. J., Munro, C. L., Ashtiani, B., & Bryant, S. (2003). Oral care interventions in critical care: frequency and documentation. American Journal of Critical Care, 12(2), 113-118.
76
Grau, A. J., Becher, H., Ziegler, C. M., Lichy, C., Buggle, F., Kaiser, C., …Dörfer, C. E.
(2004). Periodontal disease as a risk factor for ischemic stroke. Stroke, 35(2), 496-501.
Griffiths, J., Jones, V., Leeman, I., Lewis, D., Patel, K., & Wilson, K. (2000).
Guidelines for the development of local standards of oral health care for dependent, dysphagic, critically and terminally ill patients. British Society for Disability and Oral Health.
Hanne, K., Ingelise, T., Linda, C., & Ulrich, P. P. (2012). Oral status and the need for oral health care among patients hospitalised with acute medical conditions. Journal of Clinical Nursing, 21(19pt20), 2851-2859.
Holmes, S., & Mountain, E. (1993). Assessment of oral status: evaluation of three oral assessment guides. Journal of Clinical Nursing, 2(1), 35-40.
Hsieh, F.-I., Lien, L.-M., Chen, S.-T., Bai, C.-H., Sun, M.-C., Tseng, H.-P., …Hsu, C.
Y. (2010). Get With The Guidelines-Stroke Performance Indicators: Surveillance of Stroke Care in the Taiwan Stroke Registry: Get With The Guidelines-Stroke in Taiwan. Circulation, 122(11), 1116-1123.
Humphrey, L. L., Fu, R., Buckley, D. I., Freeman, M., & Helfand, M. (2008).
Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. Journal of General Internal Medicine, 23(12), 2079-2086.
Jablonski, R. A., Munro, C. L., Grap, M.J., Schubert, C. M., Ligon, M., & Spigelmyer, P. (2009). Mouth care in nursing homes: knowledge, beliefs, and practices of nursing assistants. Geriatric Nursing, 30(2), 99-107.
Johnson, V. B. (2012). Oral hygiene care for functionally dependent and cognitively impaired older adults. Journal of Gerontological Nursing, 38(11), 11-19.
Jönsson, B., Ö hrn, K., Oscarson, N., & Lindberg, P. (2009). The effectiveness of an individually tailored oral health educational programme on oral hygiene behaviour
77
in patients with periodontal disease: a blinded randomized-controlled clinical trial (one-year follow-up). Journal of clinical periodontology, 36(12), 1025-1034.
Kim, H.-D., Sim, S.-J., Moon, J.-Y., Hong, Y.-C., & Han, D.-H. (2010). Association between periodontitis and hemorrhagic stroke among Koreans: a case-control study. Journal of periodontology, 81(5), 658-665.
Kıran, M., Arpak, N., Ü nsal, E., & Erdoğan, M. F. (2005). The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. Journal of clinical periodontology, 32(3), 266-272.
Kuramoto, C., Watanabe, Y., Tonogi, M., Hirata, S., Sugihara, N., Ishii, T., & Yamane, G. (2011). Factor analysis on oral health care for acute hospitalized patients in Japan. Geriatrics & gerontology international, 11(4), 460-466.
Lam, O. L., McMillan, A. S., Samaranayake, L. P., Li, L. S., & McGrath, C. (2013).
Randomized Clinical Trial of Oral Health Promotion Interventions Among Patients Following Stroke. Archives of Physical Medicine and Rehabilitation, 94(3), 435-443.
Lam, O. L., McGrath, C., Li, L. S., & Samaranayake, L. P. (2012). Effectiveness of oral hygiene interventions against oral and oropharyngeal reservoirs of aerobic and facultatively anaerobic gram-negative bacilli. American journal of infection control, 40(2), 175-182.
Lee, S., Shafe, A. C., & Cowie, M. R. (2011). UK stroke incidence, mortality and cardiovascular risk management 1999-2008: time-trend analysis from the General Practice Research Database. British Medical Journal Open, 1(2), e000269.
Loesche, W. J., Schork, A., Terpenning, M. S., Chen, Y.-M., Kerr, C., & Dominguez, B.
L. (1998). The relationship between dental disease and cerebral vascular accident in elderly United States veterans. Annals of periodontology, 3(1), 161-174.
Mahasweta, V. (2009, no date). Oral health status and treatment needs of stroke
78
(cerebrovascular accident) survivors visiting rehabilitation centers of hospitals in bangalore. Retrieved June 5, 2013, from http://119.82.96.198:8080/jspui/handle /123456789/3182
Millns, B., Gosney, M., Jack, C. I., Martin, M. V., & Wright, A. E. (2003). Acute Stroke Predisposes to Oral Gram-Negative Bacilli – a Cause of Aspiration Pneumonia? Gerontology, 49(3), 173-176.
Mojon, P., Budtz-Jørgensen, E., & Rapin, C. -H. (1999). Relationship between oral health and nutrition in very old people. Age and ageing, 28(5), 463-468.
Noble, J. M., Borrell, L. N., Papapanou, P. N., Elkind, M. S., Scarmeas, N., & Wright, C. B. (2009). Periodontitis is associated with cognitive impairment among older adults: analysis of NHANES-III. Journal of Neurology, Neurosurgery &
Psychiatry, 80(11), 1206-1211.
Padilha, D. M., Hugo, F. N., Hilgert, J. B., & Dal Moro, R. G. (2007). Hand function and oral hygiene in older institutionalized Brazilians. Journal of the American Geriatrics Society, 55(9), 1333-1338.
Prendergast, V., Jakobsson, U., Renvert, S., & Hallberg, I. R. (2012). Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: results of a randomized controlled trial. Journal of Neuroscience Nursing, 44(3), 134-146.
Prendergast, V., Kleiman, C., & King, M. (2013). The Bedside Oral Exam and the Barrow Oral Care Protocol: Translating evidence-based oral care into practice.
Intensive and Critical Care Nursing, 29(5), 282-290.
Preston, A. J., Kearns, A., Barber, M. W., & Gosney, M. A. (2006). The knowledge of healthcare professionals regarding elderly persons' oral care. British dental journal, 201(5), 293-295.
Raghunathan, S., Freeman, A., & Bhowmick, B. (2009). Mouth care after stroke. GM:
79
Midlife and Beyond, 39(10), 582-586.
Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Benjamin, E. J., Berry, J. D., Borden, W.
B., …Turner, M. B. (2012). Heart Disease and Stroke Statistics—2012 Update: A Report From the American Heart Association. Circulation, 125(1), e2-e220.
Salamone, K., Yacoub, E., Mahoney, A., & Edward, K. (2013). Oral Care of
Hospitalised Older Patients in the Acute Medical Setting. Nursing Research and Practice, 2013, Article ID 827670, 4 pages.
Schillinger, T., Kluger, W., Exner, M., Mlekusch, W., Sabeti, S., Amighi, J., …Schillinger, M. (2006). Dental and Periodontal Status and Risk for Progression of Carotid Atherosclerosis: The Inflammation and Carotid Artery Risk for Atherosclerosis Study Dental Substudy. Stroke, 37(9), 2271-2276.
Sfyroeras, G. S., Roussas, N., Saleptsis, V. G., Argyriou, C., & Giannoukas, A. D.
(2012). Association between periodontal disease and stroke. Journal of Vascular Surgery, 55(4), 1178-1184.
Simpson, T. C., Needleman, I., Wild, S. H., Moles, D. R., & Mills, E. J. (2010).
Treatment of periodontal disease for glycaemic control in people with diabetes.
Australian Dental Journal, 55(4), 472-474.
Söder, P.-Ö ., Söder, B., Nowak, J., & Jogestrand, T. (2005). Early carotid
atherosclerosis in subjects with periodontal diseases. Stroke, 36(6), 1195-1200.
Stein, P. S., Desrosiers, M., Donegan, S. J., Yepes, J. F., & Kryscio, R. J. (2007). Tooth loss, dementia and neuropathology in the Nun study. The Journal of the American Dental Association, 138(10), 1314-1322.
Talbot, A., Brady, M., Furlanetto, D. L., Frenkel, H., & Williams, B. O. (2005). Oral care and stroke units. Gerodontology, 22(2), 77-83.
Taylor, G. W., & Borgnakke, W. S. (2008). Periodontal disease: associations with diabetes, glycemic control and complications. Oral Diseases, 14(3), 191-203.
80
Terezakis, E., Needleman, I., Kumar, N., Moles, D., & Agudo, E. (2011). The impact of hospitalization on oral health: a systematic review. Journal of clinical
periodontology, 38(7), 628-636.
Terpenning, M. S., Taylor, G. W., Lopatin, D. E., Kerr, C. K., Dominguez, B. L., &
Loesche, W. J. (2001). Aspiration pneumonia: dental and oral risk factors in an older veteran population. Journal of the American Geriatrics Society, 49(5), 557-563.
Trenter, P., & Creason, N. S. (1986). Nurse administered oral hygiene: is there a scientific basis? Journal of Advanced Nursing, 11(3), 323-331.
Truelsen, T., Begg, S., & Mathers, C (2000, no date). The global burden of cerebrovascular disease. Retrieved August 17, 2013, from http://
www.who.int/healthinfo/statistics/bod_cerebrovasculardiseasestroke.pdf Tsai, C., Hayes, C., & Taylor, G. W. (2002). Glycemic control of type 2 diabetes and
severe periodontal disease in the US adult population. Community dentistry and oral epidemiology, 30(3), 182-192.
Van Lancker, A., Verhaeghe, S., Van Hecke, A., Vanderwee, K., Goossens, J., &
Beeckman, D. (2012). The association between malnutrition and oral health status in elderly in long-term care facilities: A systematic review. International journal of nursing studies, 49(12), 1568-1581.
Weening-Verbree, L., Huisman-de Waal, G., van Dusseldorp, L., van Achterberg, Y., &
Schoonhoven, L. (2013). Oral health care in older people in long term care
facilities: A systematic review of implementation strategies. International journal of nursing studies, 50(2013), 569-582.
World Health Organization (2013, no date). STEPwise approach to stroke surveillance.
Retrieved August 17, 2013, from http://www.who.int/chp/steps/stroke/en/
Yaacob, M., Worthington, H. V., Deacon, S. A., Deery, C., Walmsley, A. D., Robinson,
81
P. G., & Glenny, A. M. (2014). Powered versus manual toothbrushing for oral health. The Cochrane Library. Retrieved May 19, 2015, from
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002281.pub3/abstract Yoneyama, T., Yoshida, M., Ohrui, T., Mukaiyama, H., Okamoto, H., Hoshiba,
K., …Members Of The Oral Care Working Group. (2002). Oral care reduces pneumonia in older patients in nursing homes. Journal of the American Geriatrics Society, 50(3), 430-433.
Zhu, H., McMillan, A. S., McGrath, C., Li, L. S., & Samaranayake, L. P. (2008). Oral carriage of yeasts and coliforms in stroke sufferers: a prospective longitudinal study. Oral Diseases, 14(1), 60-66.
82
表目錄
表 1 口腔護理執行狀況計分表
分級 項目
口腔護理執行狀況等級
1 (不良) 2 (中等) 3 (良好)
1.刷牙頻率 ＜1 次/天或從來不刷 1 次/天 2 次(含以上)/天
2.刷牙用具 從來不刷 一般牙刷、海綿潔牙棒、棉花棒、
紗布、大頭軟毛牙刷
小頭軟毛牙刷、電動牙刷
3.刷牙使用清潔劑 自來水 開水或生理食鹽水 牙膏、市售漱口水
4.口乾處理 塗凡士林、未進行處置 讓病人嚼口香糖或無糖糖果 喝水、海綿清潔棒沾水潤濕、唾
液替代品、塗護唇膏、漱口 5.口乾處理頻率 從來沒潤濕過 ≧4 小時潤濕 1 次、不一定 4 小時內潤濕 1 次
6.舌頭清潔頻率 ＜1 次/天或從來不清潔 1 次/天 2 次(含以上)/天
7.舌頭清潔用具 從來不清潔 硬毛牙刷、海綿潔牙棒、湯匙、棉
花棒
刮舌器、紗布、軟毛牙刷、舌刷
刮舌器、紗布、軟毛牙刷、舌刷