Tmj acting up again, what are my next options?

Night guard: If you have not been fitted for a night guard this would be the least invasive next step. Make sure you only have a dentist that is fluent in proper fabrication and adjustment of said night guard. The store bought guards do not take into account your occlusion.

Evaluation: If you haven't done so yet but a thorough examination and definitive diagnosis is needed. Many times small things can help such as soft food diet, heating pads, physical therapy. There are other instances where you may need your bit adjusted from orthodontics (braces) or full mouth reconstruction (crowns and bridges to new bit) or an appliance to help with your bit. An evaluation is important.

Consultation: Do not try and fix your problem/problems on your own by looking into an otc mouthpiece for grinding/clenching. You should see a dentist or tmj/tmd specialist to evaluate your symptoms and treat the problems. Was your tmj/tmd treated by a dentist/tmj specialist or did the problem just subside on its own? Tmj/tmd us never really cured, but can be maintained and controlled with the right knowledge.

A few ideas: Depends on symptoms, and cause of symptoms. 3 signs of TMJ dysfunction: joint noises, joint pain & limited oral opening. Self treat with soft diet, jaw exercises, massage, heat/cold, OTC pain meds. A splint or physical therapy would be next. Occasionally muscle relaxants, biofeedback. Xrays are done for diagnosis. Surgery usually reserved for serious symptoms not responsive to other treatments.

Research: I suggest you research a dentist in your area with extensive training and experience treating patients with TMJ\TMD. Many dentists can treat the simple cases but professionals who can truly diagnose and treat the more complicated or chronic cases are few and far between. Ask for referrals from health care professionals in your area. Local Dental Society or Teaching Hospital or Dental School also.