A 9-yr-old girl tragically died just hours after falling asleep in the car following a dental appointment, reports The Mirror.
Silvanna Moreno had started experiencing tooth pain in October last year, according to a post-mortem report, and was later referred for surgery. Following a consultation, the procedure was scheduled for March of this year.
On March 17, the day before her surgery, Silvanna had a fever of 101 degrees Fahrenheit, according to the post-mortem report. She took Children’s Tylenol, and her symptoms appeared to improve, reports The Mirror.
The next day, she “complained of a headache” but didn’t seem overly unwell. Around 10am local time, she was placed under general anaesthesia for a dental procedure lasting approximately three hours.
Dreamtime Dentistry in Vista, California confirmed the procedure was performed under general anaesthesia due to her age and intense anxiety surrounding the experience. Afterward, she was taken to a recovery room, where she appeared “out of it” and was “incomprehensibly mumbling,” as stated in the post-mortem and cited by The Mirror.
Silvanna was wheeled out of the office but could reportedly stand and was helped into a car. During the drive home, she fell asleep. Once home, she remained asleep for about 90 minutes before her snoring began to “quiet and slow,” reports The Mirror.
Her family kept checking on her, but when she became “unresponsive,” they called emergency services at 4:46pm. They performed CPR until paramedics arrived and took her to the hospital.
Despite resuscitation efforts at Rady Children’s Hospital, Silvanna was pronounced dead at 5:44pm local time, reports The Mirror.
Her cause of death was identified as methemoglobinemia linked to recent nitrous oxide exposure, per the post-mortem findings by the San Diego County Medical Examiner’s Office.
On Friday, May 30, a Dreamtime Dentistry representative said they had been “not aware of a fever nor any illness” and that Silvanna’s temperature was normal on the day of the procedure.
“Dreamtime Dentistry’s records show that the patient’s mother completed and signed a pre-operative check-in form indicating ‘NO’ when asked if the patient was sick. Dr. Watkins follows standard protocol. Had he been informed of any recent fever or illness, especially within 24 hours of the procedure, it would have been rescheduled until the patient was healthy,” reports The Mirror.
Dr. Ryan Watkins previously said Silvanna was a “healthy nine-year-old with a history of regular medical checkups” and that her medical and dental histories were thoroughly reviewed before the operation. He added, “all medications were administered according to manufacturer guidelines based on Silvanna’s age and weight.”
Watkins stated that Silvanna “never exhibited” symptoms of methemoglobinemia during or after the surgery. He said she remained under observation “until she was awake with stable vital signs” and that when released to her mother’s care, she was “awake, alert, and with all protective reflexes intact,” having passed checks for “oxygenation, respiratory stability, consciousness, post operative pain, nausea and vomiting, and gait,” reports The Mirror.
The Medical Examiner’s report listed other factors contributing to her death, including the administration of multiple medications: “dexamethasone, glycopyrrolate, hydromorphone, isoflurane, ketorolac, midazolam, ondansetron, propofol, and sevoflurane.”
Dreamtime Dentistry defended the medication use, saying they were “standard anesthesia drugs commonly used in pediatric dental sedation procedures” and that “any interactions or negative side effects were not due to dosage but instead due to her rare but undiagnosed/undetected medical condition,” reports The Mirror.
Watkins said, “While the Medical Examiner has ruled this an accident, we take this outcome with the utmost seriousness. We are conducting a thorough internal review of this case and are consulting with leading experts in dental anesthesia to ensure we continue to provide the safest possible care for our patients.” He reiterated, “While the Medical Examiner has ruled this an accident, we take this outcome with the utmost seriousness. We are conducting a thorough internal review of this case and are consulting with leading experts in dental anesthesia to ensure we continue to provide the safest possible care for our patients,” reports The Mirror.
He added, “we extend our deepest condolences to Silvanna’s family and ask for continued respect for their privacy during this time of grief,” reports The Mirror.
Silvanna’s family has since launched a GoFundMe campaign to raise money for funeral costs for their “bright and joyful” daughter, sharing heartfelt tributes. The fundraiser describes her as “a bright and loving third grader at Sherman Elementary School in San Diego. She was the sunshine in every room she entered, always greeting staff and classmates with a big smile and an even bigger hug. Her friends describe her as kind, caring, and always happy, a true friend to everyone she met. She was also an amazing big sister to Roberto, showing love and devotion every day,” reports The Mirror.
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