'Healthy' nine-year-old girl fell asleep after dentist appointment but was dead hours later

A nine-year-old girl who fell asleep in the car on the way home from the tragically died just hours later.

Silvanna Moreno first complained of tooth pain in October last year, according to the autopsy report, and was eventually referred for surgery and after a consultation, the was booked for March this year.

On March 17, the morning before the procedure, Silvanna had a 101-degree fever, according to the autopsy report. She took Children's Tylenol and her symptoms appeared to resolve. The next morning, she "complained of a headache" but did not appear distressed — and around 10am local time, she was placed under anesthesia for the procedure, which lasted about three hours.

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The Dreamtime Dentistry in Vista, California confirmed the procedure was peformed under general anesthesia due to her young age and acute situational anxiety. After the procedure, she was taken to a room to recover during which time she was described as being "out of it" and "incomprehensibly mumbling," according to the autopsy report.

Silvanna left the office in a wheelchair but was reportedly able to stand up and be helped into the backseat of a car. On the drive home she fell asleep and when they got home, she stayed asleep for about an hour and a half before her began "quieting and slowing."

Moreno’s family checked on her rergularly but when she became "unresponsive," they called 911 at 4:46pm. They conducted CPR until first responders arrived and rushed her to hospital. Staff at Rady Children’s Hospital tried to save her but were unsucessful and she was pronounced dead at 5:44pm local time.

Her cause of death was listed as methemoglobinemia in the setting of recent nitrous oxide administration, according to a San Diego County Medical Examiner's Office (SDCME) autopsy report.

In a statement on Friday, May 30, a spokesperson for Dreamtime Dentistry claimed they were "not aware of a fever nor any illness" and that Silvanna had a normal temperature the day of the procedure, reports .

"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."

In his own statement, Dr. Ryan Watkins previously described Silvanna as a "healthy nine-year-old with a history of regular medical checkups" and said that she underwent a "thorough review of her medical and dental history" before the procedure. Watkins also said that "all medications were administered according to manufacturer guidelines based on Silvanna's age and weight."

Watkins said Silvanna “never exhibited” warning signs of methemoglobinemia throughout either the procedure or her recovery. According to Watkins, Silvanna remained under observation "until she was awake with stable vital signs" — and before being released into her mother's care "awake, alert, and with all protective reflexes intact," the child was checked for "oxygenation, respiratory stability, consciousness, post operative pain, nausea and vomiting, and gait."

In addition to her cause of death, the medical examiner listed contributing factors as the "administration of dexamethasone, glycopyrrolate, hydromorphone, isoflurane, ketorolac, midazolam, ondansetron, propofol, and sevoflurane." According to Dreamtime Dentistry, all of those medications are "standard anesthesia drugs commonly used in pediatric dental sedation procedures" and they claim that "any interactions or negative side effects were not due to dosage but instead due to her rare but undiagnosed/undetected medical condition."

“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," Watkins said.

Added Watkins, "we extend our deepest condolences to Silvanna's family and ask for continued respect for their privacy during this time of grief."

Moreno's family has set up a page to raise money to cover the funeral cost of their 'bright and joyful' daughter. The fundraiser said: "Silvanna was 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."

You can donate to the GoFundMe page by