Once any anesthesia or sedation has taken effect, your dentist will work on removing the tooth.
If you are undergoing a simple extraction, your dentist will use an elevator to slightly lift the tooth. Then, they will grip it with forceps and rock it back and forth to break the ligaments that are keeping it in place. The local anesthesia will prevent you from feeling pain, but you pay feel some pressure or a pulling sensation.
Surgical extractions are more complex and might require that your dentist creates incisions in your gums or even breaks a tooth into pieces. Like a simple extraction, you might feel some pressure, as well as tugging and pulling sensations. You should not notice any pain.