A dental visit in San Diego ended in tragedy after 9-year-old Silvanna Moreno died just hours after undergoing a procedure that included sedation and multiple dental treatments. The case has drawn attention from both the public and medical reviewers as details continue to emerge about what happened before and after the appointment. Silvanna had reportedly been dealing with ongoing tooth pain for several months before being referred to Dreamtime Dentistry in Vista for treatment.
On March 18, she attended the clinic for a scheduled procedure that lasted several hours and included a root canal, crown placement, and the removal of several decayed teeth, both primary and permanent. In the period leading up to the appointment, the child had experienced dental discomfort, and her mother later reported that she had a fever the day before the procedure, which was treated with children’s medication. However, the dental clinic stated that a pre-operative form completed before treatment indicated the patient was not sick at the time.
According to the clinic, if they had been made aware of any recent illness or fever, the procedure would have been postponed until the child was fully healthy. This detail has become part of the ongoing review of the case and the circumstances surrounding the treatment. Pre-operative screening is a standard requirement in sedation dentistry, especially for pediatric patients, as it helps reduce risks associated with anesthesia and underlying medical conditions.
Dental Treatment and Sedation Process
On the day of the procedure, Silvanna was treated at Dreamtime Dentistry by Dr. Ryan Watkins, who served as both the dentist and the anesthesiologist for the procedure. Sedation was administered before the dental work began, and the clinic later reported that the procedure was completed without any immediate complications.
The clinic stated that the child was closely monitored throughout the treatment and recovery process. After the procedure, she was discharged in stable condition, reportedly awake and with normal vital signs, and released into her mother’s care following standard post-anesthesia protocols.
Condition After Leaving the Clinic
After returning home, Silvanna appeared drowsy, which is commonly expected after sedation-based procedures. Family members reported that she was sleeping heavily and seemed heavily affected by the anesthesia.
As time passed, her condition appeared to change. Her breathing reportedly became slower, and her family noticed she was increasingly unresponsive. Concerned about her condition, relatives checked on her multiple times.
Eventually, the child stopped responding, and emergency services were contacted at approximately 4:46 p.m., several hours after she had received anesthesia at the dental clinic.
Emergency Response and Hospital Treatment
Paramedics arrived and transported Silvanna to Rady Children’s Hospital in San Diego for urgent medical care. Upon arrival, hospital staff determined that she was in asystole, a condition where the heart has stopped electrical activity and is no longer pumping blood.
Medical teams attempted resuscitation efforts immediately, including emergency life-saving procedures. Despite these efforts, the child could not be revived and was later pronounced dead at the hospital.
Asystole is considered a severe cardiac emergency, and outcomes depend heavily on how quickly treatment is initiated.
Medical Examiner’s Findings
Following an examination, the medical examiner determined that the cause of death was methemoglobinemia in the setting of recent nitrous oxide administration.
Methemoglobinemia is a rare blood condition that affects the blood’s ability to carry oxygen effectively. It can occur in rare cases involving exposure to certain medications or anesthetic agents and is considered a serious medical complication.
Reports also indicated that multiple anesthetic drugs were used during the procedure, which may have been contributing factors in the case. Medical literature notes that such conditions are extremely rare but can be life-threatening when they occur.
Statements From the Dental Clinic
Dreamtime Dentistry stated that the patient was continuously monitored during the procedure and showed no visible signs of distress at the time of treatment or recovery. The clinic also reported that oxygen levels remained within normal ranges while she was under care.
Dr. Ryan Watkins stated in comments to media outlets that no warning signs of methemoglobinemia were observed during or after the procedure. He added that if any symptoms had been identified, emergency steps would have been taken immediately, including hospital transfer.
The clinic has confirmed that an internal review is underway to examine the circumstances of the case and ensure that all procedures followed established safety guidelines.
Previous Professional Review
Reports have also noted that Dr. Watkins was previously investigated by the California Dental Board in connection with an earlier case in 2016 involving a patient who experienced a serious medical emergency during anesthesia.
That earlier case resulted in a lawsuit that was later settled, and the dentist reportedly underwent a period of professional probation from 2020 to 2023 following regulatory review.
These past proceedings have drawn renewed public attention in light of the recent incident, as officials and investigators review the full professional history involved.
Ongoing Investigation and Public Response
As of now, Silvanna Moreno’s death has been ruled accidental. However, an internal review at the dental practice is ongoing, and additional evaluations are being conducted to better understand the sequence of events.
The case has deeply impacted the local community in San Diego, where the family and others continue to mourn the loss of a young child following what was intended to be a routine dental procedure.
Authorities and medical professionals are continuing to examine the case to determine whether all protocols were followed correctly and whether any additional contributing factors played a role.
