A routine dental visit turned into a heartbreaking tragedy for 9-year-old Silvanna Moreno, who passed away on March 18, 2025, a few hours after undergoing a dental procedure at Dreamtime Dentistry in Vista, California. The cause of her death has been ruled an accident by the San Diego County Medical Examiner’s Office, more than two months after the incident.
Cause of Death: Methemoglobinemia
The official cause of Silvanna’s death was listed as “methemoglobinemia in the setting of recent nitrous oxide administration.” Methemoglobinemia is a rare blood condition that occurs when nitrous oxide, commonly used in dental procedures as an anesthetic, affects hemoglobin, the protein in red blood cells responsible for carrying oxygen throughout the body. This condition can lead to hypoxia, or a lack of oxygen, in the tissues.
While methemoglobinemia can manifest with symptoms like blue or purple lips, skin, or nails, some individuals may not show any noticeable signs. In Silvanna’s case, she had been given Tylenol the day before the procedure due to a fever, though there was no immediate indication that she had any underlying health issues.
The Dental Procedure
Silvanna was a new patient referred to Dreamtime Dentistry for a root canal on one of her molars. During the procedure, some baby teeth and one permanent decayed tooth were extracted. Dr. Ryan Watkins, the office’s trained anesthesiologist, stated that Silvanna was healthy with a history of regular medical checkups and underwent the office’s standard preoperative evaluation. He added that she was deemed an appropriate candidate for outpatient general anesthesia.
Post-Procedure Complications
After the procedure, Silvanna was moved to a recovery room, where her mother reported that the child appeared “out of it,” occasionally opening her eyes and mumbling incomprehensively. On the way home, Silvanna continued to sleep, and when they arrived home, her breathing began to slow. Despite attempts to wake her up, her condition worsened, and her family called 911.
Silvanna was rushed to the hospital but was tragically pronounced dead.
Previous Investigations
This incident follows a previous investigation into Dr. Ryan Watkins in 2016, after a 54-year-old man nearly died while under general anesthesia at his practice. The Dental Board of California determined that one of the drugs administered to the patient was inappropriate and had caused his heart to stop. Watkins was placed on probation from 2020 to 2023 as a result of the incident.
Community Outpouring
The dental office expressed their profound sadness over the loss, with Dr. Watkins stating, “We are profoundly saddened by the tragic loss of Silvanna Moreno, and our hearts continue to go out to her family during this incredibly difficult time.”
GoFundMe
Silvanna’s death has left her family and the community in mourning as they try to come to terms with the unexpected loss.
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