A routine trip to the dentist in San Diego County has resulted in a devastating loss, claiming the life of 9-year-old Silvanna Moreno just hours after she underwent an extensive dental procedure. The case has sent shockwaves through the community, particularly as the administering dentist had been previously investigated in connection with a near-fatal patient incident.
Silvanna, a resident of San Diego, had been suffering from persistent molar pain since October 2024. After months of discomfort, she was referred to Dreamtime Dentistry in Vista for a root canal. On the morning of March 18, the child was taken in for a lengthy, three-hour procedure that included a root canal, the placement of a crown, and the extraction of several decayed teeth—a combination of both baby and permanent teeth—according to reporting by People.
The Unreported Fever and Disputed History
Adding a layer of complexity to the tragedy, Silvanna’s mother, Itzel de Jesús, reported that the child had experienced a fever the day before the procedure, which had been managed with children’s Tylenol.
However, a spokesperson for Dreamtime Dentistry has publicly contested this claim, asserting that the clinic was unaware of any recent illness. The LA Times reports that Moreno’s mother “completed and signed a pre-operative check-in form indicating ‘No’ when asked if the patient was sick.” The clinic has maintained that had it been informed of the illness, the surgery “would have been rescheduled until the patient was healthy,” per the statement given to People.
Procedure and Discharge: “Continuously Monitored”
The procedure began around 10 a.m. Dr. Ryan Watkins, the dentist and the sole anesthesiologist listed at the clinic, administered the sedative and successfully completed the extensive dental work without any immediate complications.
In a statement provided to FOX 5 San Diego, Dreamtime Dentistry claimed the young girl was “continuously monitored by our dentist anesthesiologist” and exhibited no signs of trouble throughout the surgery or during the recovery phase.
“Following the procedure, she was discharged in stable condition – awake, with stable vital signs and protective reflexes intact – into her mother’s care, following our standard post-anesthesia protocols,” the statement affirmed.
The Critical Hours: Breathing Slows and Silence Falls
After waking and being discharged, Silvanna, who was initially able to open her eyes and stand, was described by her family as “out of it” and heavily snoring during the drive home. Upon arrival, she was carried inside, where she continued to sleep—snoring loudly—for approximately 90 minutes.
Then, the situation took a sharp turn. Her breathing began to slow, and the loud snoring became quieter. Her concerned grandmother checked the child’s heart rate twice. After the second check, Silvanna was unresponsive. Emergency services were immediately called at 4:46 p.m. local time, nearly six hours after the administration of anesthesia.
Flatlined: A Rare and Fatal Blood Disorder
The child was rushed to Rady Children’s Hospital, where doctors found she was in asystole—a condition commonly known as a “flat line,” where the heart’s electrical system fails, causing it to stop pumping. As the Cleveland Clinic explains, asystole is deadly within minutes without immediate CPR. Despite desperate life-saving measures, Silvanna, one of four children, tragically died in the hospital.
The medical examiner later determined the cause of death to be “methemoglobinemia in the setting of recent nitrous oxide administration,” suggesting the condition was likely triggered by the anesthetic used during the dental procedure. Methemoglobinemia (MetHb) is an extremely rare blood disorder typically caused by exposure to certain medications or chemicals. NBC News cited the contributing factors to her death as the use of multiple anesthetic drugs during the procedure—a combination that proved fatal for the 9-year-old.
A Past Under Scrutiny
In a subsequent statement, Dr. Watkins referenced the rare condition “that can occur with nitrous oxide administration.” He stressed that Silvanna “never exhibited” any warning signs of MetHb during or after the procedure, with her oxygen saturation levels remaining within a normal range throughout. Watkins added: “If we had observed any indication of methemoglobinemia, we would have immediately discontinued the procedure and transported her to the hospital for emergency treatment.” He also stated that his team had followed standard safety protocols and performed a thorough review of the child’s history.
However, this is not the first time Dr. Watkins’s procedures have drawn official scrutiny.
In 2016, as reported by NBC, Watkins was investigated by the Dental Board of California after a 54-year-old male patient nearly died while under his care. The man had been given a combination of two anesthetic drugs, one of which state investigators determined should never have been administered to him. The patient’s heart temporarily stopped, leading to a lawsuit that was eventually settled. As a result of that investigation, Watkins was placed on professional probation, which lasted from 2020 to 2023.
As of now, Silvanna’s death has been ruled accidental. An internal review of the incident is currently underway at Dreamtime Dentistry.
A Critical Conversation on Dental Safety
This incident is profoundly disturbing and raises serious concerns about the safety protocols and risk management involved in dental procedures requiring deep sedation, particularly for children. The fact that the tragedy was linked to the rare but known risk of methemoglobinemia triggered by anesthetic drugs, coupled with the dentist’s past disciplinary history, compels a critical public conversation.
It brings up several key questions for patients and healthcare providers:
-
Pre-Operative Transparency: How comprehensive is the pre-operative screening process, and what level of detail must parents provide regarding minor, recent illnesses to ensure patient safety?
-
Anesthesia Protocol and Risk: What safeguards are in place when multiple anesthetic agents are used on children, and are dentists performing sedation fully equipped to handle rare, immediate, and potentially life-threatening complications?
-
Public Awareness of Disciplinary History: Should patients have easier access to a practitioner’s disciplinary record, especially when undergoing high-risk procedures like general anesthesia?
This tragic case is a heartbreaking reminder that even routine medical and dental visits carry inherent risks, and that transparency and meticulous adherence to safety protocols are non-negotiable.
