Per-and polyfluoroalkyl substances (PFASs) are fluorinated organic chemicals that are concerning due to their environmental persistence and adverse human and ecological effects. Remediation of environmental PFAS contamination and their presence in consumer products have led to the production of solid and liquid waste streams containing high concentrations of PFASs, which require efficient and cost-effective treatment solutions. PFASs are challenging to defluorinate by conventional and advanced destructive treatment processes, and physical separation processes produce waste streams (e.g., membrane concentrate, spent activated carbon) requiring further post-treatment. Incineration and other thermal treatment processes are widely available, but their use in managing PFAS-containing wastes remains poorly understood. Under specific operating conditions, thermal treatment is expected to mineralize PFASs, but the degradation mechanisms and pathways are unknown. In this review, we critically evaluate the thermal decomposition mechanisms, pathways, and byproducts of PFASs that are crucial to the design and operation of thermal treatment processes. We highlight the analytical capabilities and challenges and identify research gaps which limit the current understanding of safely applying thermal treatment to destroy PFASs as a viable end-of-life treatment process.