Microbiological and toxicity analyses of the synthetic polymer polyhexamethylene guanidine hydrochloride against endodontic microorganisms.

Failures in endodontic treatments are common due to microbial resistance in the pulp canal. The study evaluated the in vitro activity of polyhexamethylene guanidine hydrochloride (PHMGH) against endodontic strains, as well as in vivo toxicity. Using minimum inhibitory concentration and minimum bactericidal concentration techniques, PHMGH was effective against all microorganisms, even at low concentrations. At 50.0 µg/mL, it inhibited Enterococcus faecalis; furthermore, when compared to chlorhexidine (CLX), it demonstrated values 19 times lower against Candida albicans. The polymer's activity was also determined by agar diffusion, evaluating products A (calcium hydroxide - Ca(OH)2, as a reference), B (Ca(OH)2 combined with physiological solution, reference with a vehicle), C (PHMGH 6.25%), D (PHMGH 3.125%), E (PHMGH 1.5625%), F (PHMGH 0.78125%), G (PHMGH 6.25% and Ca(OH)2), H (PHMGH 3.125% and Ca(OH)2), I (PHMGH 1.5625% and Ca(OH)2), J (PHMGH 0.78125% and Ca(OH)2), and K (positive control, CLX 0.12%). Products containing PHMGH were more effective than the references against all strains, and C, D, and G were more effective than CLX against Peptostreptococcus anaerobius, Actinomyces naeslundii, and Actinomyces viscosus. According to the fractional inhibitory concentration index, the combination of PHMGH and CLX showed indifference for Peptostreptococcus anaerobius, Actinomyces naeslundii, Actinomyces viscosus and Escherichia coli, antagonism for Candida albicans, and synergy for Enterococcus faecalis. The toxicity of PHMGH at different concentrations was tested in Caenorhabditis elegans and did not show lethality in nematodes, with the LC50 observed only at the highest concentration (100 µg/mL) after two days of exposure. It is suggested that PHMGH exhibited antimicrobial activity against endodontic strains and low toxicity, raising expectations for new preventive and therapeutic products in endodontics.