No guidelines for the oral care of children fed by tube have been published. Poor oral health (unrestored caries lesions, poor oral hygiene, dependence for oral care) and tube-feeding are associated with the development of aspiration pneumonia. Children fed by tube have abundant calculus, and low caries activity. The potential for dental erosion related to gastro-esophageal reflux and oral hypersensitivity is high. To optimize oral health and reduce the risk of aspiration pneumonia, this population should receive dental care at more frequent intervals than children fed orally. Modifications to dental procedures are suggested to minimize the risks associated with dental treatment. Evidence-based treatment guidelines are indicated to optimize dental care for children fed by tube.