A 72-year-old woman comes to the community clinic with questions regarding toothbrushes. Currently, she is using a large-headed, hard-bristled toothbrush that is approximately 15 months old. She states that her gums have been quite tender lately and she has been scrubbing those areas more aggressively because she fears there may be cavities there. She also states that her arthritis has been acting up lately and she is having difficulties holding the floss. The patient also states she is using herbal toothpaste that does not contain fluoride.