The death of a 9-year-old girl was found to be a rare blood disease after dentistry in San Diego County, according to an autopsy report from the San Diego County Medical Examination Office.
Silvanna Moreno died from a disease called methoglobinemia, which may be triggered by nitrous oxide and other anesthetics used during dental surgery on March 18, medical examiners said.
Metallurglobin is a rare blood disease that destroys how the iron in hemoglobin delivers oxygen to cells and tissues in the body.
It is extremely rare for a person to be born with this disease – due to rarity, there is no exact number of people affected. More commonly, experts who have studied this situation say it can be developed through abnormal fusion of events involving drug exposure, which can happen in the case of Moreno.
It is not clear whether Moreno has congenital hyperproducible globulomaemia, which means it exists at birth or is a form triggered by exposure to certain drugs.
Dr. Michael Levine of UCLA Health says the disease can cause symptoms such as shortness of breath, fatigue and blue discoloration of cyanide or skin.
“Sometimes people have flaws in that system, so they get productive players who are born with congenitality,” said Gentry Wilkerson, Ph.D., associate professor at the University of Maryland School of Medicine. “I'm so rare that I'd be shocked if I saw it in my career.”
Lieutenant Travis Easter said the San Diego Police Department’s child abuse department announced it was investigating the girl’s death, but the department said Friday it had stopped investigating and closed the case.
Dreamtime Dentistry of Moreno's facility underwent surgery, Vision, responded to reports from medical examiners, saying the death was not a dose but was caused by a rare but undiagnosed/undiscovered medical condition. “The Dental Office also said there was no clear sign that she had this condition before the surgery.
“The common cause of methoglobinemia may be dental surgery because one of the drugs they will provide for patients with tooth pain is benzocaine,” Wilkerson said.
Benzocaine was not listed as one of the drugs taken by Moreno in the report of a medical examiner.
Dental procedures are often very safe, Wilkerson said. But, in other cases, “it’s a drug-dose-dependent effect where a person can take an overdose or overdose of the drug and then subsequently develop methoglobinemia,” Levine said.
Moreno was referred to Dreamtime Dental after complaining about toothache four months ago, according to an autopsy reviewed by The New York Times.
The Dental Office received a referral because it provided Moreno “treatment under general anesthesia due to age and acute situational anxiety”, the facility said.
The day before the surgery on March 18, Moreno's autopsy said she had a fever, but her symptoms were resolved after being given to Child Tylenol.
Representatives at Dreamtime Dental told The Times that they were unaware of her fever, noting that Moreno's mother “completed and signed the preoperative check-in form, noting that when asked if the patient was ill, she directed 'no'.”
According to a statement from Dream Time Dentistry, the OP's evaluation includes a comprehensive review of Moreno's medical and dental history, an assessment of vital signs, physical examinations including heart, lung sound and airway assessments, and other procedures.
“All drugs are managed according to Moreno's age and weight manufacturer guidelines,” the agency's statement said.
The Dental Office said that throughout the process, anesthesiologist Dr. Ryan Watkins observed Moreno and had no complications. After the operation is completed, the child will be monitored in the recovery area of the facility until she wakes up with stable vital signs.
After the operation, she was taken to her mother's care and sent home, according to the San Diego Medical Examiner's Office.
Moreno fell asleep while riding home, and when she got home, she fell asleep and was transitioned to bed. Her family checked her throughout the day and called 911 when she later found out she was not responding.
First responders transported Moreno to Rady Children Hospital, while taking lifesaving measures.
When the child arrived at the hospital, medical staff took life-saving measures, to no avail and she was pronounced dead, according to the medical examiner.
