An Update on VAT for Custom Made Dental Devices

A useful update has been recently shared with lab association members on where dental splints stand in regard to VAT, and following further enquiries, this is an update on my previous article.

Since the Align ruling landed, most discussion, including my own piece, has treated splints as sitting in the same "at risk" category as retainers, orthodontic appliances and mouthguards, on the logic that they protect or move teeth rather than replace them, so the same reasoning that caught aligners would seem to catch them too.

That guidance adds an important piece of nuance to the picture.

The key point: the Tribunal never actually ruled on splints or other custom made devices. HMRC v Align Technology was about aligners specifically. The Tribunal’s narrower definition of a dental prosthesis, an item that replaces missing or damaged teeth, is what caught aligners. Nobody has taken that definition to a court and tested it against splints or other custom made devices, yet.

Here is the part that matters practically. HMRC’s own published guidance, VATHLT2490, still explicitly lists splints as exempt dental prostheses, alongside dentures, bridges, crowns, obturators and individual artificial teeth. That guidance hasn’t been updated since the Align decision. It is worth remembering too, HMRC did quietly strip orthodontic appliances out of this same guidance back in February 2024, well before any of this reached a tribunal. Splints were not included in the 2024 edit.

That gap, a narrower legal test on one side, unchanged published guidance on the other, is where we currently appear to sit. The view being shared with members is that labs making splints have a reasonable basis to rely on HMRC’s current published position and shouldn’t feel pressured into changing their VAT treatment purely because of the Align outcome. That rests on a real legal principle called ‘legitimate expectation’, the idea that a taxpayer can reasonably rely on clear published guidance until HMRC formally changes it. It’s a genuine legal concept, not a loophole, though it isn’t a guarantee and it doesn’t override the law itself.

Where this leaves things overall. Only aligners are actually settled by the Tribunal itself, standard rated, following a ruling specifically on aligners. Splints, retainers and expanders were never ruled on at all. HMRC’s guidance list doesn’t just name splints, it also includes a catch all category, "other specially designed appliances," which arguably covers retainers and other orthodontic appliances too. On that basis, the same reasoning being applied to splints, unchanged published guidance, no court ruling against them, a reasonable basis to rely on the current position, arguably extends to retainers and other custom made devices as well, at least until HMRC says otherwise.

Sports mouthguards and bleaching trays are a different matter. These are standard rated. They were already subject to the standard rate and they don’t appear on HMRC’s exempt list.

A final caveat to all of the above, tax and VAT are complex and nuanced, I am not an accountant or a VAT expert, it is always best to seek professional advice regarding your own tax and VAT affairs.

There are some great pointers here for labs, and for now, this guidance means very few labs need to change anything immediately, aligner producers aside. But "no action needed yet" and "unaffected" are not the same thing, and that’s worth sitting with.

I will be watching the subject very closely, as my prediction is that once HMRC sees an opportunity to gain more tax receipts, they may look a little closer at "cosmetic dentistry."