We would like to thank Alison Drayton, John O'Sullivan and Graham Watson for their kind comments regarding our editorial1 and for reinforcing the importance of maintaining good oral health and regular dental care for patients at increased risk of developing infective endocarditis, such as those with adult congenital heart disease (ACHD). Although we principally focused on cost as a barrier to such patients accessing dental care, Drayton et al also raise the issue of dental phobia as a barrier to effective dental care. In their study of 50 ACHD patients, just over one third cited anxiety/dislike of the dentist as the main reason for non-attendance at their dentist compared with 17% who mentioned cost.

We would agree that there are multiple barriers to patients attending the dentist and these will vary for each individual or …