How do dentists pull out a tooth without using laughing gas?

Local anesthesia: Nitrous oxide does not numb up a tooth. It is just a mild sedative. Local anesthetic is always used to deaden the pain fibers for an extraction.

Numbing the tooth: With or without laughing gas, your dentist will numb the tooth and the area where it is before extracting it. The gas is only there to relax you and help you suffer less anxiety during the procedure.

Local anesthesia: A tooth is extracted after numbing up the area with an injection of local anesthesia. Laughing gas can be used as a relaxing agent to make everything go easier and seem quicker but is not essential to the procedure. For difficult extractions\impacted teeth some patients prefer IV sedation but that too is not necessary in almost all cases.