To most parents, a referral for a child’s root canal is a routine, if slightly nerve-wracking, chore. You schedule the appointment, prepare some soft foods for the recovery, and trust the medical professionals to do their jobs.
But for Itzel de Jesús, a routine trip to a pediatric dental clinic in Vista, California, ended in every parent’s worst nightmare.
Just hours after undergoing a lengthy dental procedure under anesthesia, her nine-year-old daughter, Silvanna Moreno, died in her sleep. The tragedy has not only devastated a San Diego family of six but has also trained a harsh spotlight on the rare medical condition that claimed her life—and the checkered past of the dentist who administered the sedation.
A Lengthy Procedure and an Unseen Fever
Silvanna’s ordeal began long before she sat in the dental chair. Since October 2024, the little girl had struggled with persistent, agonizing tooth pain. Hoping to finally resolve the issue, she was referred to Dreamtime Dentistry for a comprehensive procedure on March 18.
It was not a minor visit. Over the course of three hours, Silvanna underwent a root canal, had a crown placed, and had several decayed baby and permanent teeth extracted.
In the background of this major dental surgery was a quiet complication: the day before the procedure, Silvanna had run a fever. Her mother had managed it with children’s Tylenol, and by the morning of the appointment, the fever had broke.
However, Dreamtime Dentistry later asserted they had no idea the child had been unwell. The clinic claimed that de Jesús completed a pre-operative form checking “No” to the question of whether her child was sick. Had they known, the clinic stated, the extensive surgery would have been postponed.
The Quiet Fade at Home
At approximately 10:00 a.m. that morning, Dr. Ryan Watkins—the clinic’s dentist and sole anesthesiologist—administered the sedative. According to the clinic, the surgery went smoothly. They maintained that Silvanna’s vital signs remained stable throughout, and she was discharged into her mother’s care “awake, with protective reflexes intact.”
When Silvanna got into the car, she was understandably “out of it,” but she was able to open her eyes and stand. Once home, her family carried her inside, where she immediately fell into a deep sleep.
For about an hour and a half, Silvanna slept, snoring heavily—a sound her family assumed was just the heavy weight of the anesthesia wearing off.
But then, the room grew quiet.
Silvanna’s snoring grew softer, and her breathing visibly slowed. Sensing something was wrong, her grandmother checked the little girl’s heart rate. Finding it weak, she checked again moments later. This time, Silvanna was entirely unresponsive.
At 4:46 p.m., nearly six hours after she had been put under, the family desperately called 911. Paramedics rushed Silvanna to Rady Children’s Hospital, but she arrived in asystole—the medical term for a flatline, meaning the heart’s electrical system had completely failed. Despite exhaustive life-saving efforts, the nine-year-old was pronounced dead.
The Silent Killer: Methemoglobinemia
How does a child go from a dental chair to a fatal cardiac arrest in a matter of hours?
The medical examiner’s autopsy pointed to a highly unusual and devastating culprit: methemoglobinemia, brought on by the recent administration of nitrous oxide (commonly known as laughing gas) in combination with other anesthetic drugs.
What is Methemoglobinemia? It is a rare blood disorder where the body produces an abnormal amount of methemoglobin, a form of hemoglobin. While hemoglobin’s job is to carry oxygen through your blood to your organs, methemoglobin holds onto that oxygen, refusing to release it to the tissues. Essentially, the body’s organs are starved of oxygen from the inside out, even if the patient appears to be breathing.
The condition can be inherited, but it is far more commonly “acquired” after exposure to certain chemicals or anesthetics.
Dr. Watkins defended his team’s actions, emphasizing that Silvanna’s oxygen saturation levels remained perfectly normal during her time at the clinic and that she showed absolutely no symptoms of the condition before being discharged.
“If we had observed any indication of methemoglobinemia, we would have immediately discontinued the procedure and transported her to the hospital for emergency treatment,” Watkins said in a public statement.
A History of Medical Scrutiny
While the medical examiner has ruled Silvanna’s death an accident, the tragedy has inevitably reopened old wounds regarding Dr. Watkins’ medical license.
An investigation reveals this is not the first time Watkins’ sedation practices have resulted in a life-or-death crisis.
In 2016, the Dental Board of California investigated Watkins after a 54-year-old male patient went into cardiac arrest under his care. In that case, investigators found that Watkins had administered a combination of two sedatives, one of which should never have been given to that specific patient.
Though the man survived and later settled a lawsuit against the dentist, the state took disciplinary action. The Dental Board placed Watkins on a strict professional probation that lasted from 2020 until 2023.
While Dreamtime Dentistry conducts an internal review and the state authorities look into the details of Silvanna’s tragic death, a family of four children is left to navigate life without their bright, nine-year-old sister. It is a sobering reminder that even in the most sterile clinical settings, the margin between a routine procedure and a catastrophic medical event can be razor-thin.