The PRIMA Model: A Heuristic Multilevel Framework for the Clinical Evaluation and Management of Bruxism

Bruxism is a multifactorial masticatory muscle behaviour with complex mechanisms and heterogeneous clinical expression, ranging from physiological to potentially harmful depending on its consequences. Frameworks such as the STAB enable structured data collection but were not designed to guide the interpretation of findings when management is clinically warranted.

To present the PRIMA model (Pattern-Responsive Inference Model for Multidomain Assessment of Bruxism), an exploratory, hypothesis-generating framework intended to support-not replace-structured clinical reasoning. PRIMA organises validated clinical inputs into an interpretable, multidomain map that may assist clinicians in orienting management decisions in cases where bruxism produces clinically significant consequences, without assuming causal inference or implying that every assessed case requires intervention.

PRIMA follows a five-step modular architecture. Structured STAB items include predefined response options, each assigned a score through a three-tier heuristic logic that reflects domain-specific implication. Rather than forcing each item into a single domain, items are mapped through a weighted attribution scheme, in which an item may contribute to more than one Functional Domain according to a constrained, rule-based set of weights (primary weight to the domain of measurable expression, secondary weight to a literature-supported aetiological driver). These weighted item scores are aggregated into Functional Tendency Scores (FTS) for four Functional Domains. In parallel, contextual risk elements (Aggravating Factors) are weighted through the Aggravating Factor Index (AFI), a multidimensional metric that modulates the interpretation of domain expression. Where domain expression and contextual burden suggest clinical salience, proportionally stratified therapeutic options may be considered through a three-tier logic formalised as the Intra-Domain Therapeutic Sequencing Logic (ITSL).

The model provides a reproducible scaffold for stepwise reasoning. Illustrative, synthetically constructed cases are used to demonstrate the internal logic and transparency of the framework, not to provide evidence of clinical efficacy or validity.

PRIMA is proposed as an exploratory, hypothesis-generating framework to support structured reasoning in the interpretation of bruxism and in the planning of management when clinically indicated. It is not a validated diagnostic algorithm or therapeutic protocol; it has not undergone prospective or outcome-based validation, and future clinical studies are required to determine its reliability, utility, and impact on diagnostic prioritisation and therapeutic decisions.