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Background Offering equitable access to dental care remains a challenge and methods to risk-stratify individuals to prioritize care could help to attain that goal. The interaction of multiple risk factors associated with oral disease vulnerability can outweigh protective factors conferring resilience and resistance to individuals and their communities; however, there is no validated instrument for measuring oral disease vulnerability. Hence, the objective of this study was to develop a Dental Vulnerability Scale (EVO) for primary health care (PHC) and evaluate its content validity and internal structure. Methods This was a psychometric study conducted in São Paulo, Brazil, in 2019. During content validation, 172 items were evaluated by a panel of 40 judges with diverse background and with the application of the Content Validity Ratio (CVR), considering a critical CVR value&amp;gt; 0.26. During the internal structure evaluation, the EVO was applied to a sample of 1227 individuals in the PHC setting and the results were analyzed using Exploratory and Confirmatory Factor Analysis, in addition to the application of 3 reliability indicators (Cronbach's alpha, McDonald's Omega and Greatest Lower Bound). Results The CVR was 0.33 for relevance and 0.39 for clarity, resulting in 41 items. The final EVO was composed of 4 dimensions (general health, oral health, infrastructure and health services) with a total of 15 items. Factor loadings ranged from 0.37 to 0.96, with R-squared values ranging from 0.14 to 0.91. The reliability indicators values were α = 0.64, ω = 0.99 and GLB=0.82. The Goodness of fit were NNFI = 0,95, CFI = 0,98, GFI = 0,96 and AGFI = 0,97. The EVO instrument was considered valid to be used among oral health professionals in the PHC setting. Conclusions The EVO showed satisfactory psychometric properties and could be employed by health professionals and managers to plan actions and*inform* policies related to oral health. Key messages The EVO could be used to risk-stratify individuals in the PHC setting. The EVO could help to inform oral health policies.

Development and validation of the dental vulnerability scale in the primary health care setting