A routine dental visit in San Diego County ended in tragedy on March 18, 2025, when nine-year-old Silvanna Moreno died just hours after an extensive dental procedure. Silvanna, a local resident who had been struggling with persistent molar pain since October 2024, had been referred to Dreamtime Dentistry in Vista for comprehensive treatment, including a root canal, placement of a crown, and the extraction of several decayed teeth. What was intended as a standard corrective procedure turned fatal, sending shockwaves through the community. The dentist involved, Dr. Ryan Watkins, had a history of scrutiny after a near-fatal patient incident in 2016, raising additional concerns about oversight, risk management, and patient safety during sedation-based dental procedures.

The lead-up to the procedure included a disputed medical history that has complicated the investigation. Silvanna’s mother, Itzel de Jesús, reported that her daughter had a fever the day before the appointment, which had been temporarily managed with children’s Tylenol. Dreamtime Dentistry publicly contested this claim, stating that the clinic had no knowledge of any recent illness. According to the LA Times, Moreno’s mother had signed a pre-operative check-in form indicating that Silvanna was not sick. The clinic emphasized that had they been made aware of any illness, the procedure would have been rescheduled until she was medically cleared. This discrepancy has become central to public and legal scrutiny, raising questions about communication and parental disclosure in pediatric dental care.

The procedure itself began at 10 a.m., and according to clinic statements, Silvanna was continuously monitored by Dr. Watkins, who served as both the dentist and the anesthesiologist. Despite the length and complexity of the three-hour session, no immediate complications were reported. Dreamtime Dentistry confirmed that Silvanna exhibited stable vital signs, protective reflexes, and normal responsiveness during recovery, and she was discharged in stable condition to her mother’s care. The clinic’s official statements framed the procedure and immediate post-operative period as routine and safely managed, in line with standard post-anesthesia protocols.

Tragedy struck during the critical hours following her discharge. Silvanna, initially alert enough to open her eyes and stand, became unusually drowsy and heavily snored during the car ride home. Once inside, she continued sleeping for approximately ninety minutes, during which her breathing gradually slowed. Her grandmother monitored her heart rate and, after the second check, found her unresponsive. Emergency services were called at 4:46 p.m., nearly six hours after anesthesia administration. Silvanna was rushed to Rady Children’s Hospital, where she was found in asystole, a condition in which the heart ceases to beat. Despite emergency resuscitation efforts, she was pronounced dead. The rapid decline highlighted how quickly complications from anesthesia-related conditions can become fatal, even when standard protocols appear to have been followed.

A medical examiner later determined the cause of death to be methemoglobinemia in the setting of recent nitrous oxide administration. Methemoglobinemia is an extremely rare blood disorder in which the oxygen-carrying capacity of blood is impaired, and it can be triggered by certain anesthetic drugs. Multiple anesthetic agents administered during Silvanna’s procedure likely contributed to the fatal outcome. Dr. Watkins stated that there were no warning signs of the condition during or after the surgery, and that oxygen saturation remained within normal ranges. He asserted that the procedure adhered to established safety protocols and emphasized that, had there been any indication of methemoglobinemia, immediate medical intervention would have been initiated. Despite these assurances, the case raises critical questions regarding anesthetic risk management in pediatric dental care.

The incident also casts a spotlight on Dr. Watkins’ professional history. In 2016, he was investigated by the California Dental Board following a near-fatal incident involving a 54-year-old patient. That patient had been administered two anesthetic drugs, one of which was deemed inappropriate, resulting in cardiac arrest. Watkins was placed on probation from 2020 to 2023, illustrating past concerns regarding sedation protocols. This history has intensified public scrutiny in light of Silvanna’s death, particularly regarding the disclosure of disciplinary actions to patients and their families. The combination of the dentist’s past record, the rare but known risk of methemoglobinemia, and the disputed pre-operative disclosure has fueled a broader conversation about safety, oversight, and transparency in pediatric dentistry.

The tragedy underscores the inherent risks of even routine dental procedures requiring deep sedation. It raises urgent questions about pre-operative screening, anesthetic safety, and public access to practitioners’ disciplinary histories. Key issues include ensuring parents provide accurate medical information, verifying that dental teams are equipped to detect and respond to rare complications, and whether regulatory measures could improve the safety of high-risk pediatric procedures. Silvanna’s death, while officially ruled accidental, serves as a sobering reminder that rigorous adherence to safety protocols, meticulous risk management, and transparency are essential to protect vulnerable patients. The case has sparked ongoing reviews and calls for heightened awareness to prevent similar losses in the future.